A Two-Time-Period Comparison of the Effects of Ambient Air Pollution on Outpatient Visits for Acute Respiratory Illnesses (original) (raw)
Related papers
Journal of the Air & Waste Management Association, 2004
Particulate matter (PM) has been associated with adverse respiratory outcomes in numerous studies that utilized data from emergency room visits, hospital admissions, and mortality records. This study is unique in its investigation of associations of air pollution measures, including components of PM, with health outcomes in an ambulatory-care setting. Visit data were collected from Kaiser Permanente, a not-for-profit health maintenance organization in the metropolitan Atlanta, GA, area. Kaiser Permanente collaborated on the Aerosol Research Inhalation Epidemiological Study (ARIES), which provided detailed information on the characteristics of air pollutants. The Kaiser Permanente study was a time-series investigation of the possible associations between daily levels of suspended PM, inorganic gases, and polar volatile organic compounds and ambulatory care acute visit rates during the 25-month period from August 1, 1998, to August 31, 2000. For this interim analysis, the a priori 0-2 days lagged moving average, as well as the 3-5 days and 6-8 days lagged moving averages, of air quality measures were investigated. Single-pollutant Poisson general linear modeling was used to model daily visit counts for asthma and upper and lower respiratory infections (URI and LRI) by selected air quality metrics, controlling for temporal trends and meteorological variables. Most of the statistically significant positive associations were for the 3-5 days lagged air quality metrics with child asthma and LRI. METHODS Air Pollution Data Air pollution data were collected as part of the Aerosol Research and Inhalation Epidemiological Study (ARIES). ARIES relates several health outcomes to air pollution: mortality, emergency department visits, outpatient physician visits, and personal exposure. ARIES is unique in the range of pollutants measured, including PM, specific PM components, gases, and VOCs. This structure allows for a more detailed investigation of the associations between health and air pollution. Following intensive planning and peer review, investigators began 25 months of field monitoring in Atlanta, GA, in August 1998 (referred to as the "superstation" time period). Pollutants were IMPLICATIONS This study provides a unique assessment of air quality and health effects by investigating the associations between a wide range of air pollutants and ambulatory care visits. Findings from this study and the few others conducted in an outpatient setting have identified significant associations between air quality metrics and health outcomes, suggesting that data from outpatient, primary care settings can be a useful additional resource for air quality epidemiology. Further studies in these settings can help elaborate the interpretation of primary care visit data. In addition, with use of detailed ARIES data, air quality management possibly can be more strategic.
International Journal of Environmental Research and Public Health, 2020
Asthma affects millions of people globally and is especially concerning in populations living with poor air quality. This study examines the association of ambient outdoor air pollutants on asthma-related emergency department (ED) visits in children and adults throughout the Pittsburgh region. A time-stratified case-crossover design is used to analyze the lagged effects of fine particulate matter (PM2.5) and gaseous pollutants, e.g., ozone (O3), sulfur dioxide (SO2), nitrogen dioxide (NO2), and carbon monoxide (CO) on asthma-related ED visits (n = 6682). Single-, double-, and multi-pollutant models are adjusted for temperature and analyzed using conditional logistic regression. In children, all models show an association between O3 and increased ED visits at lag day 1 (OR: 1.12, 95% CI, 1.03–1.22, p < 0.05) for the double-pollutant model (OR: 1.10, 95% CI: 1.01-1.20, p < 0.01). In adults, the single-pollutant model shows associations between CO and increased ED visits at lag d...
Modification of the Effect of Ambient Air Pollution on Pediatric Asthma Emergency Visits
Epidemiology, 2014
Background-Children may have differing susceptibility to ambient air pollution concentrations depending on various background characteristics of the children. Methods-Using emergency department (ED) data linked with birth records from Atlanta, Georgia, we identified ED visits for asthma or wheeze among children aged 2-16 years from 1 January 2002 through 30 June 2010 (n=109,758). We stratified by preterm delivery, term low birth weight, maternal race, Medicaid status, maternal education, maternal smoking, delivery method, and history of a bronchiolitis ED visit. Population-weighted daily average concentrations were calculated for 1-hour maximum carbon monoxide and nitrogen dioxide; 8-hour maximum ozone; and 24-hour average particulate matter less than 10 microns in diameter, particulate matter less than 2.5 microns in diameter (PM 2.5), and the PM 2.5 components sulfate, nitrate, ammonium, elemental carbon, and organic carbon, using measurements from stationary monitors. Poisson time-series models were used to estimate rate ratios for associations between three-day moving average pollutant concentrations and daily ED visit counts and to investigate effect-measure modification by the stratification factors. Results-Associations between pollutant concentrations and asthma exacerbations were larger among children born preterm and among children born to African American mothers. Stratification by race and preterm status together suggested that both factors affected susceptibility. The largest estimated effect size (for an interquartile-range increase in pollution) was observed for ozone among preterm births to African American mothers: rate ratio=1.138 (95% confidence interval=1.077-1.203). In contrast, the rate ration for the ozone association among full-term births to mothers of other races was 1.025 (0.970-1.083). Conclusions-Results support the hypothesis that children vary in their susceptibility to ambient air pollutants.
American Journal of Respiratory and Critical Care Medicine, 2010
Scientific Knowledge of the Subject: Certain outdoor air pollutants can trigger asthma exacerbations. To advance understanding of the relationships between ambient air pollutant concentrations and asthma exacerbations among children, further characterization of the dose-response and pollutant lag effects are needed, as are investigations of pollutant species beyond the commonly measured criteria pollutants. What this Study Adds to the Field: In our large, population-based study we observed that both ozone and primary pollutants from traffic sources independently contributed to the burden of emergency department visits for pediatric asthma. These associations tended to be of the highest magnitude for concentrations on the day of the emergency department visit and were present at relatively low ambient concentrations.
ISEE Conference Abstracts, 2018
Previous studies have found strong associations between asthma morbidity and major ambient air pollutants. Relatively little research has been conducted to assess whether age is a factor conferring susceptibility to air pollution-related asthma morbidity. We investigated the short-term relationships between asthma emergency department (ED) visits and ambient ozone (O 3), carbon monoxide (CO), nitrogen dioxide (NO 2), sulfur dioxide (SO 2), and fine particulate matter (PM 2.5) in Atlanta (1993-2009), Dallas (2006-2009), and St. Louis (2001-2007). City-specific daily time-series analyses were conducted to estimate associations by age group (0-4, 5-18, 19-39, 40-64, and 65+ years). Sub-analyses were performed stratified by race and sex. City-specific rate ratios (RRs) were combined by inverse-variance weighting to provide an overall association for each strata. The overall RRs differed across age groups, with associations for all pollutants consistently strongest for children aged 5-18 years. The patterns of association across age groups remained generally consistent when models were stratified by sex and race, although the strong observed associations among 5-18 year olds appeared to be partially driven by non-white and male patients. Our findings suggest that age is a susceptibility factor for asthma exacerbations in response to air pollution, with school-age children having the highest susceptibility.
Environmental Pollution, 2017
The effects of fine particles (PM 2.5) on asthma have been widely confirmed by epidemiological research studies. However, a limited number of studies have investigated the relationship between exposure to different PM 2.5 components and asthma. We characterized the PM 2.5 components in a suburban site of central Taiwan and conducted a time-stratified case-crossover study to elaborate the effects of daily concentration of each PM 2.5 component on asthma outpatient visits. We retrieved asthma outpatient claims for individuals less than 20 years old with a residential address in the Shalu district, Taiwan, from the National Health Insurance Research Database during 2000e2010. Multiple linear regression models were used to back extrapolate the historic concentration of individual components of PM 2.5 from 2000 through to 2010, including black carbon (BC) and eight ions, namely, sulfate, nitrate (NO 3 À), ammonium, chloride, potassium (K þ), magnesium, calcium, sodium. The odds ratio (OR) with a 95% confidence interval (CI) of individual PM 2.5 components on asthma was estimated by conditional logistic regression. A total of 887 asthma outpatient visits with individuals who have an average age of 7.96±3.88 years were selected. After adjusting for confounders, we found an interquartile range (IQR) increase in BC level, an IQR increase in NO 3 À level, and an IQR increase in K þ level that were all associated with the increased risk of asthma outpatient visits from the current day (OR ¼ 1.18, 95% CI: 1.05e1.34; OR ¼ 1.11, 95% CI: 1.01 e1.21; and OR ¼ 1.16, 95% CI: 1.04e1.30, respectively). The effects of these components on asthma were stronger in the cold season than in the warm season. However, we did not find any lagging effects. The results suggest that exposure to NO 3 À , BC, and K þ derived from industry-related combustion or motor vehicles emission sources may increase the risk of asthma outpatient visits, particularly during the cold season.