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Objectives: The primary purpose of this study is to analyze the relationshipbetween the first occurrence of hospitalization for cardiovascular disease(CVD) and particulate matter less than 2.5 micrometre in diameter (PM2.5)exposure, considering average PM2.5 concentration and the frequency of highPM2.5 concentration simultaneously. Methods: We used large-scale cohort datafrom seven metropolitan cities in South Korea. We estimated hazard ratios (HRs)and 95% confidence intervals (CIs) using the Cox proportional-hazards model,including annual average PM2.5 and annual hours of PM2.5 concentrationexceeding 55.5 microgram/m3 (FH55). Results: We found that the risk waselevated by 11.6% (95% CI, 9.7-13.6) for all CVD per 2.9 microgram/m3 increaseof average PM2.5. In addition, a 94-h increase in FH55 increased the risk ofall CVD by 3.8% (95% CI, 2.8-4.7). Regarding stroke, we found that people whowere older and had a history of hypertension were more vulnerable to PM2.5exposure. Conclusion: Based on the findings, we conclude that accurateforecasting, information dissemination, and timely warning of highconcentrations of PM2.5 at the national level may reduce the risk of CVDoccurrence.

Effects of Fine Particulate Matter on Cardiovascular Disease Morbidity: A Study on Seven Metropolitan Cities in South Korea