The impact of PM2.5 on acute otitis media in children (aged 0-3): A time series study

Long-term exposure to air pollution and precocious puberty in South Korea

BACKGROUND AND AIM

The increasing prevalence of precocious puberty (PP) has emerged as a significant medical and social problem worldwide. However, research on the relationship between long-term air pollution exposure and PP has been relatively limited. We thus investigated the association between long-term air pollution exposure and the onset of PP in South Korea.

METHODS

We investigated a retrospective cohort using the Korea National Health Insurance Database. Six-year-old children born from 2007 to 2009 were examined (2013-2015). We included boys ≤10 years and girls aged ≤9 years who visited hospitals for early pubertal development, were diagnosed with PP per the ICD-10 (E228, E301, and E309), and received gonadotropin-releasing hormone agonist treatment. We analyzed data for boys up until 10 years old (60-month follow-up) and for girls up to 9 years old (48-month follow-up). We assessed the association between long-term air pollution exposure and the onset of PP using a Cox proportional hazard model. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) per 1 μg/m3 increase in fine particulate matter (PM2.5) and particulate matter (PM10) and per 1 ppb increase in sulfur dioxide (SO2), nitrogen dioxide (NO2), and ozone (O3).

RESULTS

This study included 1,205,784 children aged six years old between 2013 and 2015. A positive association was found between the 48-month moving average PM2.5 (HR: 1.019; 95% CI: 1.012, 1.027), PM10 (HR: 1.009; 95% CI: 1.006, 1.013), SO2 (HR: 1.037; 95% CI: 1.018, 1.055), and O3 (HR: 1.006; 95% CI: 1.001, 1.010) exposure and PP in girls but not boys.

CONCLUSIONS

This study provides valuable insights into the harmful effects of air pollution during childhood and adolescence, emphasizing that air pollution is a risk factor that should be managed and reduced.

Air pollutants, seasonal influenza, and acute otitis media in children: a population-based analysis using 22-year hospitalization data

BACKGROUND

Acute otitis media (AOM) is a prevalent childhood acute illness, with 13.6 million pediatric office visits annually, often stemming from upper respiratory tract infections (URI) and affected by environmental factors like air pollution and cold seasons.

METHODS

Herein, we made use of territory-wide hospitalization data to investigate the relationships between meteorological factors, air pollutants, influenza infection, and AOM for children observed from 1998 to 2019 in Hong Kong. Quasi-Poisson generalized additive model, combined with a distributed-lag non-linear model, was employed to examine the relationship between weekly AOM admissions in children and weekly influenza-like illness-positive (ILI +) rates, as well as air pollutants (i.e., oxidant gases, sulfur dioxide, and fine particulate matter), while accounting for meteorological variations.

RESULTS

There were 21,224 hospital admissions due to AOM for children aged ≤ 15 years throughout a 22-year period. The cumulative adjusted relative risks (ARR) of AOM were 1.15 (95% CI, 1.04-1.28) and 1.07 (95% CI, 0.97-1.18) at the 95th percentile concentration of oxidant gases (65.9 ppm) and fine particulate matter (62.2 μg/m3) respectively, with reference set to their medians of concentration. The ARRs exhibited a monotone increasing trend for all-type and type-specific ILI + rates. Setting the reference to zero, the cumulative ARRs of AOM rose to 1.42 (95% CI, 1.29-1.56) at the 95th percentile of ILI + Total rate, and to 1.07 (95% CI, 1.01-1.14), 1.19 (95% CI, 1.11-1.27), and 1.22 (95% CI, 1.13-1.32) for ILI + A/H1N1, A/H3N2, and B, respectively.

CONCLUSIONS

Our findings suggested that policy on air pollution control and influenza vaccination for children need to be implemented, which might have significant implications for preventing AOM in children.

Otitis media: Interactions between host and environment, immune and inflammatory responses

OBJECTIVE

To review and highlight progress in otitis media (OM) research in the areas of immunology, inflammation, environmental influences and host-pathogen responses from 2019 to 2023. Opportunities for innovative future research were also identified.

DATA SOURCES

PubMed database of the National Library of Medicine.

REVIEW METHODS

Key topics were assigned to each panel member for detailed review. Search of the literature was from June 2019 until February 2023. Draft reviews were collated, circulated, and discussed among panel members at the 22nd International Symposium on Recent Advances in Otitis Media in June 2023. The final manuscript was prepared and approved by all the panel members.

CONCLUSIONS

Important advances were identified in: environmental influences that enhance OM susceptibility; polymicrobial middle ear (ME) infections; the role of adaptive immunity defects in otitis-proneness; additional genes linked to OM; leukocyte contributions to OM pathogenesis and recovery; and novel interventions in OM based on host responses to infection. Innovative areas of research included: identification of novel bacterial genes and pathways important for OM persistence, bacterial adaptations and evolution that enhance chronicity; animal and human ME gene expression, including at the single-cell level; and Sars-CoV-2 infection of the ME and Eustachian tube.

Effects of air pollution on emergency visits for acute otitis media among children: a case-crossover study in Chongqing, China

Background

Many epidemiological studies have demonstrated the short-term effects of air pollution on acute otitis media (AOM) in children, but few studies have explored the association between AOM and air pollution in Chinese children. This study aimed to analyze the effects of air pollution on emergency visits for AOM among children through a time-stratified case-crossover design in Chongqing, China.

Methods

The outpatient medical records of children from nine main urban districts who presented with AOM between December 22, 2018 and December 21, 2021 were collected from the Children's Hospital of Chongqing Medical University. Data for air pollution variables, including the air quality index (AQI), particulate matter ≤ 10 μm (PM10), PM2.5, SO2, CO, NO2 and O3 from 17 monitoring sites were collected. Data for meteorological factors as confounding variables also were collected. Conditional logistic regression was used to analyze the data with single-pollutant models, multi-pollutant models, and stratified analyses.

Results

Increases in AQI, PM10, PM2.5, SO2, CO and NO2 were positively associated with emergency visits for AOM among children in single-pollutant models and stratified analyses. Increases in PM10, SO2, CO and NO2 were positively associated with emergency visits for AOM among children in multi-pollutant models. NO2 had the most statistically significant OR values in all models, whereas significant effects of O3 were observed only in seasonal stratification. In single-pollutant models, we found that the best lag periods were lag 0-7 for air pollution variables except for O3 and the largest OR values were 1.185 (95%CI: 1.129-1.245) for SO2 in single-pollutant models. In stratified analyses, there were no difference between groups in these statistically significant OR values through gender and age stratification, while the differences between seasons in these OR values of PM10, SO2, CO, NO2 and O3 were statistically significant. Children aged 0 years and 3-5 years represented the most susceptible population, and among the seasons, susceptibility was greater during Winter and Spring.

Conclusion

Short-term exposure to air pollution can increase emergency visits for AOM among children in Chongqing, China.

Effects of ambient air pollution on cause-specific hospitalizations in Wuhan during 2017-2019

BACKGROUND

Few studies have focused on the associations between air pollutants and multiple organ system diseases in the entire hospitalized population. The present study aims to explore the short-term effects of six routinely monitored air pollutants on the broad causes of hospital admissions and estimate the resulting hospital admission burdens.

METHODS

Daily hospital admission records from 2017 to 2019 were obtained from the Wuhan Information center of Health and Family Planning. Generalized additive models (GAMs) were employed to evaluate the effects of air pollutants on the percent increase in the cause-specific daily number of hospital admissions. Increased hospital admission numbers, days, and expenses were also estimated.

RESULTS

A total of 2636,026 hospital admissions were identified. We found that both PM_2.5 and PM₁₀ increased the risk of hospital admissions for most disease categories. Short-term exposure to PM_2.5 was positively associated with hospitalizations of several rarely studied disease categories, such as diseases of the eye and adnexa (2.83%, 95%CI: 0.96-4.73%, P < 0.01) and diseases of the musculoskeletal system and connective tissue (2.17%, 95% CI: 0.88-3.47%, P < 0.001). NO₂ was observed to have a robust effect on diseases of the respiratory system (1.36%, 95%CI: 0.74-1.98%, P < 0.001). CO was significantly associated with hospital admissions for six disease categories. Furthermore, each 10-μg/m³ increase in PM_2.5 was associated with an annual increase of 13,444 hospital admissions (95% CI: 6239-20,649), 124,344 admission days (95% CI: 57,705-190,983), and 166-million-yuan admission expenses (95% CI: 77-255).

CONCLUSION

Our study suggested that particulate matter (PM) had a short-term effect on hospital admissions of most major disease categories and resulted in a considerable hospital admission burden. In addition, the health effects of NO₂ and CO emissions require more attention in megacities.

Particular matter influences the incidence of acute otitis media in children

Particulate matter (PM) is the main component of air pollution. Children are vulnerable to PM and acute otitis media (AOM), which is one of the most common diseases in children. However, studies on the relationship between AOM in children and PM are rare and their results are inconsistent. The aim of this study is to investigate the effect of PM on AOM in children on the basis of the Korea National Health Insurance service (NHIS) claims data. NHIS claim data from 2008 to 2015 was used to identify outpatient visits, antibiotic use to treat AOM, and demographic data. This data was combined with the data on PM_2.5 (≤ 2.5 μm) and PM₁₀ (≤ 10 μm according to its aerodynamic diameter) level extracted from air pollution data from Korean National Institute of Environmental Research for 16 administrative regions. The children with AOM were divided into three age groups (< 2, 2–4, 5–10 years). Generalized linear Poisson regression model was used to estimate the association between AOM and PM using daily counts of AOM and daily mean PM concentrations. It was adjusted to temperature, wind, humidity, season, year, age, and region. With an increase in PM_2.5 of 10 μg/m³, the relative risk of OM increased by 4.5% in children under 2 years of age. The effect of PM_2.5 was strongest influence on the day of exposure. The exposure to PM₁₀ was related to the incidence of AOM on the day of exposure and the following seven days in all three age groups. The PM concentrations did not strongly affect either AOM duration or the use of antibiotics to cure AOM. The RR in the each lag day after exposure to PM₁₀ was diverse according to the age groups. Regardless of PM size and children’s age, the PM levels are positively related to the incidence of AOM. Both PM_2.5 and PM₁₀ have the most adverse effects on children under 2 years of age and on the day of exposure.

Is Short-Term Exposure to PM2.5 Relevant to Childhood Kawasaki Disease?

Background: Kawasaki disease (KD) is an acute febrile vascular disease of unknown cause that affects the whole body. KD typically occurs in infants under the age of five and is found mainly in East Asian countries. Few studies have reported on the relationship between the pollutant PM_2.5 and KD, and the evidence remains irrelevant or insufficient. Objectives: We investigated the relationship between short-term exposure to PM_2.5 and KD hospitalizations using data from Ewha Womans University Mokdong Hospital, 2006 to 2016. Methods: We obtained data from the hospital EMR (electronic medical records) system. We evaluated the relationship between short-term exposure to PM_2.5 and KD hospitalizations using a case-crossover design. We considered exposures to PM_2.5 two weeks before the date of KD hospitalization. We analyzed the data using a conditional logistic regression adjusted for temperature and humidity. The effect size was calculated as a 10 μg/m³ increase in PM_2.5 concentration. We performed a subgroup analysis by sex, season, age group, and region. In the two-pollutants model, we adjusted SO₂, NO₂, CO, and O₃, but the effect size did not change. Results: A total of 771 KD cases were included in this study. We did not find any statistically significant relationship between PM_2.5 and children’s KD hospitalization (two-day moving average: odds ratio (OR) = 1.01, 95% confidence intervals (CI) = 0.95, 1.06; seven-day moving average: OR = 0.98, CI = 0.91, 1.06; 14-day moving average: OR = 0.93, CI = 0.82, 1.05). A subgroup analysis and two pollutant analysis also found no significant results. Conclusion: We did not find a statistically significant relationship between PM_2.5 and children’s KD hospitalizations. More research is needed to clarify the association between air pollution, including PM_2.5, and KD.

Short-Term Exposure to Fine Particulate Matter and Hospitalizations for Acute Lower Respiratory Infection in Korean Children: A Time-Series Study in Seven Metropolitan Cities

Although several studies have evaluated the association between fine particulate matter (PM_2.5) and acute lower respiratory infection (ALRI) in children, their results were inconsistent Therefore, we aimed to evaluate the association between short-term exposure to PM_2.5 and ALRI hospitalizations in children (0–5 years) living in seven metropolitan cities of Korea. The ALRI hospitalization data of children living in seven metropolitan cities of Korea from 2008 to 2016 was acquired from a customized database constructed based on National Health Insurance data. The time-series data in a generalized additive model were used to evaluate the relationship between ALRI hospitalization and 7-day moving average PM_2.5 exposure after adjusting for apparent temperature, day of the week, and time trends. We performed a meta-analysis using a two-stage design method. The estimates for each city were pooled to generate an average estimate of the associations. The average PM_2.5 concentration in 7 metropolitan cities was 29.0 μg/m³ and a total of 713,588 ALRI hospitalizations were observed during the 9-year study period. A strong linear association was observed between PM_2.5 and ALRI hospitalization. A 10 μg/m³ increase in the 7-day moving average of PM_2.5 was associated with a 1.20% (95% CI: 0.71, 1.71) increase in ALRI hospitalization. While we found similar estimates in a stratified analysis by sex, we observed stronger estimates of the association in the warm season (1.71%, 95% CI: 0.94, 2.48) compared to the cold season (0.31%, 95% CI: −0.51, 1.13). In the two-pollutant models, the PM_2.5 effect adjusted by SO₂ was attenuated more than in the single pollutant model. Our results suggest a positive association between PM_2.5 exposure and ALRI hospitalizations in Korean children, particularly in the warm season. The children need to refrain from going out on days when PM_2.5 is high.