Psychological Changes and Cancer Occurrence of Citizens due to Changes in Concentration before Seoul Fine Dust Policy

Background: Particulate matter and urban air pollution affect the human body and can lead to death. Epidemiological studies should consider the exposure to pollutants and the diverse responses of individuals depending on their sensitivity to the pollutants. Methods: In this study, air pollution measurements were obtained hourly at measuring stations operated by the national and local governments to increase the reliability of the measured values. A β-ray absorption method was used to analyze the measurements of fine dust and determine the particulate matter content. Results: The air pollution data were log-value to enable the comparison of data from different time periods. The comparison was made, focusing on the period of Seoul's fine dust policy. As a result, the cancer incidence rate also decreased after the policy. The data on individual characteristics were obtained from a survey of Seoul citizens conducted from 2015 to 2016 and using indicators such as the quality of life and social trust of Seoul citizens. Concludions: The survey on the living environment and residence indicated that 80% of the heads of households were men. Women had a greater dissatisfaction than men with the residential, economic, and social environments. The survey questions on well-being were related to the internal and external environment such as air pollution, noise, and fine dust.


Introduction
In recent years, a number of studies have been published on various respiratory symptoms caused by air pollution and the associated psychological and physiological evaluation of the affected individuals [1,2]. The human body is greatly influenced by the environment and various studies have been conducted to determine methods to prevent exposure to various environmental factors in the atmosphere as a result of environmental changes. Particulate matter (PM) and urban air pollution affect the human body and can lead to death [3][4][5][6]. The concentration of PM (coarse PM (PM10), fine PM (PM2.5)) in the atmosphere has been investigated in relation to respiratory and cardiovascular diseases and correlations between these diseases and the presence of fine dust have been reported [7,8]. Epidemiological studies on air pollution should consider the exposure to pollutants and the diverse responses of individuals depending on their sensitivity to the pollutants. Air pollution is very sensitive to temperature and meteorological changes and studies should take into account the changes in these factors and their impact on the results [9]. Seasonal changes in air pollution, regional characteristics, and population distribution are considered important variables, not only in Korea but also worldwide [10]. Climate change has a direct effect on the length and timing of the seasons. The prevention of the adverse health effects of environmental pollutants is required to address problems such as diseases and mortality [11]. Studies have provided evidence that the fear of exposure to various air pollutants can cause psychological effects; these studies focused on the analysis of air pollution factors affecting seasonal disease occurrence and the treatment of the diseases [12,13]. In addition, health concerns about air pollution are changing people's attitudes towards outdoor activities, causing confusion, increasing distrust in society and the state, and causing ideological conflict.
For the purpose of research, the Seoul Metropolitan Government has been implementing the policy process for the fine dust season system since 2015. I want to check the impact. There are some data on atmospheric exposure and health indicators, but there is no study confirming the correlation between recent abnormal symptoms and health anxiety factors. This study is based on the hypothesis that the correlation of PM10 and PM2.5 concentrations in Seoul, Gyeonggi, and Incheon varies seasonally. The data indicate that the population in the residential areas in Seoul is directly affected by air pollution, noise, lack of greenery, and water pollution.

Survey
A survey of Seoul citizens was conducted from 2015 to 2016 using 227 indicators (12 areas, 42 items) of the quality of life, social trust, and community consciousness. The survey included questions regarding the satisfaction with the living environment. According to the 2016 data, the score for the satisfaction with the residential environment (water supply and sewage, housing, telecommunication, traffic, green areas, etc.) was highest (6.16 points out of 10 points), the satisfaction with the social environment (welfare, disease, medical facilities, etc.) was 5.71 points, the satisfaction with the educational environment was 5.43 points, and the satisfaction with the economic environment was 5.31 points. The satisfaction based on gender was determined. The highest score was observed for the residential environment and was influenced by the factors of waterworks, sewage, housing, electricity, communication, traffic, and greenery. In the category of daily life concerns, problems related to parking had the highest proportion (49.1%), followed by street litter (40.4%), crime and violence (32.8%), and air pollution (32.3%). The low values for air pollution and water quality issues are important considering the immediate and future impacts of fine dust.

Air Pollution Data
Airborne pollution data were obtained hourly from national and local government measuring stations. The average annual concentration (less than 50 μg/㎥) and the average daily concentration (less than 100 μg/㎥) of fine dust (PM10 and PM2.5) were measured using the β-ray absorption method. This method captures PM of 10 ㎛ or less in the air (the particle size can be controlled according to the separation device). The sample is placed on filter paper for a certain period of time, permeates the betaine. The weight concentration of the PM is measured continuously. This measurement method determines the β-radiation absorbed by the dust particles on the filter paper. The analysis was conducted based on the following formula:

Statistic
The data analysis was performed using the statistical software SAS version 9.4 (SAS Institute Inc., Cary, NC, USA). We analyzed parameters for life satisfaction (living environment, economic environment, and social environment) and levels of well-being (noise, air pollution, rest spaces, lack of greenery, and water pollution). Gender differences were analyzed. A logistic regression model was used to compare the seasonal changes and regional characteristics of the PM10 and PM2.5 concentrations near the homes of the subjects. A 95% confidence interval (CI) and probability ratios (odds ratios (ORs)) were used to determine significant differences. A p-value <0.05 was considered statistically significant. The dependent variables were the individual characteristics and the local dust (PM10, PM2.5) concentrations. The independent variables were divided into categories representing gender and changes in summer.

Diagnostic Code Analysis of Cancer Registration Data
The sample of this study is a cohort of Seoul residents, Incheon, and Gyeonggi-do, and it is difficult to identify and epidemiologically approach the short-term. As a result of the cohort. In terms of policy application and management due to the characteristics of Seoul, the purpose of the protocol according to accumulation observation as the cause of disease according to the outcome was defined as follows. The customized DB confirmed the health insurance claim data (qualification, treatment DB) of all persons with a residence code from 2009 to 2019. The cohort type was an open cohort according to the residential area by year after the start of follow-up (2009). This study analyzed 15 cancers (All Cancers(C00-C96), lung Cancer(C33-C34), Stomach Cancer(C16), liver Cancer(C22), Colorectal Cancer(C18-C20), Breast Cancer(C50), Cervical Cancer(C53), Cancer of the esophagus(C15), gallbladder cancer(C23-C241), pancreatic cancer(C25), laryngeal Cancer(C32), Small intestine cancer(C17), Skin cancer(C44), Renal cancer(C64-C68), Leukemia(C91-C95), Thyroid Cancer(C73)) that were found to be induced in the environment among the representative cancers (24 types) in Korea. Table 1 results are related to the living environment of the survey subjects. First, in the survey of heads of households, males accounted for about 80% of survey subjects during 2015 to 2016, a much higher proportion than females. According to the income characteristics of Seoul, 40 million won was about 30% in 15 years. In households with an income of more than 5 million KRW, the ratio of the income to the income of over 5 million was higher than in other years, followed by the income of people with 15 years and 16 years of education. An education of more than 16 years was not investigated and has 15 years. It is confirmed that the survey respondents in Seoul have high education and high income.  Table 2 surveyed the satisfaction with the living environment (living environment, economic environment, social environment) and the well-being (noise, air pollution, resting space, water pollution, etc.). The survey data for 2015 to 2016 indicated a satisfaction with various factors related to the living environment. Life safety was significant in the data for 2015 data.

Outdoor environment
The raw data from the outdoor air pollution monitoring network were compared with the log-value data. Table 3 Tables 4 and 5, the concentration of fine dust in the Seoul area tends to be higher in the fall, winter, and spring than in the summer. This is consistent with the results of other studies. The ORs of the seasonal average PM10 concentration in 2016 are 1.47 in autumn, 2.11 times in winter, and 4.59 in spring. In Incheon, the ORs are 1.65 in the autumn, 1.60 in the winter, and 4.21 times in the spring. The Gyeonggi area showed a trend of increasing seasonal fine dust concentrations (2.26 in the autumn, 3.45 in the spring, and 6.16 in the spring). The values were statistically significant (P-value <.0001) for the fall of 2016. The OR for PM2.5 was 0.98 (statistically insignificant) and increased to 1.19 in the winter and 1.66 in the spring (1.50, 1.64, and 2.48 in Incheon). The OR values for PM10 for Gyeonggi were 1.49, 2.27, and 2.32 and were lower than the values for PM10 but were statistically significant (P-value: <.0001). In 2015, the OR values for PM10 in the autumn, winter, and spring in Seoul were 1.36, 5.77, and 6.04. In Incheon, the autumn, winter, and spring values were 1.19, 2.74, and 3.41. In Gyeonggi, the autumn, winter, and spring values were 1.65, 4.13, and 3.23.   As a result of the environmental data centered on the above data, the risk of fine dusts on the characteristics of climate change and regions (Seoul Gyeonggi and Incheon) had the same tendency. And the influence of wind confirmed direct characteristics of fine dust. Wind was blowing north and west, which had a direct effect, confirming that the impact of China was influenced by Seoul and Gyeonggi Province. These results confirm the new validation of the previous studies and can be used as good data.  In Seoul, there are many external factors for fine dust caused by Korean vehicles and external small business establishments. Accordingly, it was confirmed that the incidence of cancer was higher than Gyeonggi-do, which has many industrial complexes compared to Seoul, and Incheon, which has a high impact of fine dust and chemicals from ports. There was a statistical effect in all cancers, but it was not statistically significant in Cervical Cancer. As a result of confirming the cancer incidence rate for the seasoned policy of fine dust in urban areas, about 3% of all cancers show a continuous increase. In the first year (2019) of applying the fine dust policy, it was confirmed that the cancer incidence rate increased by 1%. And in lung cancer (C33-C34), fine dust decreased after the policy (2.7%) compared to before the policy (3.0%). In Breast Cancer (C50), fine dust decreased after policy (1.8%) compared to before policy (1.9%). In laryngeal Cancer (C32), fine dust decreased after policy (2.2%) compared to before policy (2.8%). In Small intestine cancer (C17), fine dust decreased after policy (1.6%) compared to before policy (1.8%). In skin cancer (C44), fine dust decreased after policy (1.2%) compared to before policy (1.7%). In Thyroid Cancer (C73), fine dust decreased after policy (1.8%) compared to before policy (1.9%). In addition, there was no significant difference between the start of the fine dust policy (2015), which was seriously high in 2018, and the time of policy application (2019).  [18,19]. Second, it was confirmed that the fine dust concentration and PM content exhibited seasonal fluctuations; the PM content was lower in the summer and autumn when the precipitation was higher. These results should be taken into consideration for research studies and policy development in the future [20]. It can be confirmed that future management is necessary when looking at the decrease in environmental diseases due to policy changes, such as lung cancer and skin cancer. Finally, unlike other areas, Seoul is a densely populated area, so it will have to make efforts to achieve balanced regional development in the future. In 2019, the first fine dust policy was applied only to the operation of vehicles and large buildings. In the future, it is necessary to check various variables that contribute to population movement and balanced regional development. Therefore, it is necessary to check the effect of air pollution on the perception of the people due to the psychological impact on the living environment and the welfare of the residents in Seoul, and it is necessary to check the significant difference in the reduction of the cancer incidence.

Conclusions
The purpose of this study is to check whether seasonal changes in air pollutants according to Seoul's air policy are well managed and how much they affect health. The results of this study cannot confirm the characteristics and prevalence of all regions according to seasonal characteristics. Although there is no direct relationship between the time of the questionnaire and the results of the measurements of fine dust concentration, it is suggested that this relationship should be taken into account in future studies considering the psychological aspects and their specificity. The statistical analysis showed that the seasonal characteristics of the fine dust were significant. It will be used as important data to confirm the various changes depending on how much change in the season (season) reflects the Seoul policy and whether the extension of the policy period in the future should be considered. Previous studies have indicated that the causes for the lower concentrations of fine dust in the summer were rainfall and weather conditions (wind). These fluctuations were also observed in the neighboring areas of the Seoul metropolitan area (Gyeonggi, Incheon). The satisfaction with the living environment is very low for women with regard to the residential environment, economic environment, and social environment. Afterward, the incidence of cancer showed a decreasing trend in lung cancer, etc., in some environments after the policy. In the future, it will be necessary to check the correlation between fine dust on health and cancer and to check it in consideration of psychological factors. The accuracy of these results could be improved if accurate real-time measurements of dust concentrations and individual risk information from exposure to air pollutants were available. In addition, measures for disease management should be improved.