The Association Between Air Pollution Exposure and White Blood Cell Counts: A Nationwide Cross-Sectional Survey in South Korea

Abstract

Background: The effect of air pollution, a major global health issue, on the immune system, particularly on white blood cell (WBC) counts, remains underexplored. Methods: This study utilized data from 54,756 participants in the Korean National Health and Nutrition Examination Survey to investigate the effects of short- (day of examination and 7-day averages), mid- (30- and 90-day averages), and long-term (one-, three-, and five-year averages) air pollutant exposure on WBC counts. We assessed exposure to particulate matter (PM₁₀, PM_2.5), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), ozone (O₃), and carbon monoxide (CO). Results: Linear regression with log-transformed WBC counts, adjusted for confounders, showed that PM₁₀ was positively associated with long-term exposure, PM_2.5 was negatively associated with short- and mid-term exposures, SO₂ was consistently negatively associated with short- and mid-term exposures, NO₂ and CO were positive across most periods, and O₃ was negatively associated with short- and mid-term exposures. Logistic regression analysis confirmed these findings, showing that short- and mid-term exposure to PM₁₀, PM_2.5, and SO₂ was negatively associated with the risk of belonging to the high-WBC group, while long-term exposure to PM₁₀, PM_2.5, NO₂, and CO showed positive associations with risk. Conclusions: Our findings highlight the time- and pollutant-specific associations between air pollution exposure and WBC counts, underscoring air pollution's potential impact on systemic inflammation.

Keywords: air pollution; epidemiologic studies; nitrogen dioxide; particulate matter; systemic inflammation; white blood cell count.

Figure 1

Flow chart of patient enrollment.