According to 2020 OECD data, PM2.5 concentration in South Korea was more than twice the OECD average. Perceived stress is a psychological response to environmental stressors and may vary by individual characteristics. Additionally, psychological impacts may vary across different durations of air pollution exposure. However, there has been limited attention to resilience in the planetary health system using nationally representative data. This study aims to identify factors associated with perceived stress in populations exposed to air pollution across exposure time.
This study used air pollution concentration data linked to the 2022 Korea National Health and Nutrition Examination Survey (KNHANES). We analyzed 3651 respondents aged 19 and older. Air-polluted areas were defined as the annual average of PM2.5 concentrations exceeding the Korean national standard. To assess the effects of air pollution, PM2.5 exposure was categorized into three-time scales: short, mid, and long-term periods. Perceived stress was classified as a binary variable. Binary logistic regression with complex survey design was conducted using SAS 9.4, controlling factors based on the Lalonde health field model.
Among the population living with longer PM2.5 exposure, women, youth, those with medical insurance, and those diagnosed with chronic diseases experienced higher perceived stress.
Populations living in air-polluted areas for longer periods showed higher perceived stress than those living in such areas for shorter periods. Notably, under similar environmental conditions, perceived stress may vary depending on the duration of exposure and sociodemographic and health-related characteristics. This may be caused by the difference in individuals’ environmental vulnerability and levels of resilience. This study highlights the need for targeted public health actions for vulnerable groups in the context of planetary health. Policies to reduce air pollution should be accompanied by interventions reflecting individual-level needs.
Author Contributions
Conceptualization: S.M.; Methodology: S.M. and J.-W.N.; Formal analysis: S.M.; Writing—original draft preparation: S.M.; Writing—review and editing: J.-W.N. All authors have read and agreed to the published version of the manuscript.
Funding
This research was supported by a grant of Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea (grant number: RS-2021-KH120073).
Institutional Review Board Statement
Ethical review and approval were waived for this study due to the retrospective and anonymized nature of the data.
Informed Consent Statement
Patient consent was waived due to the retrospective and anonymized nature of the data.
Data Availability Statement
The data used in this study are from the Korea National Health and Nutrition Examination Survey (KNHANES), which is maintained by the Korea Disease Control and Prevention Agency. Access to the data is open, and the data is publicly accessible. Available from:
https://knhanes.kdca.go.kr/ (accessed on 18 November 2025)
Conflicts of Interest
The authors declare no conflict of interest.
| Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
