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Nnoli NC, Linder SH, Smith MA, Gemeinhardt GL, Zhang K. The combined effect of ambient ozone exposure and toxic air releases on hospitalization for asthma among children in Harris County, Texas. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2018; 28:358-378. [PMID: 29962221 DOI: 10.1080/09603123.2018.1479515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/16/2018] [Indexed: 06/08/2023]
Abstract
This study represents an analysis of the effect of exposure to ambient ozone and toxic air releases on hospitalization for asthma among children in Harris County, Texas. Our study identified temporal and spatial variations in asthma hospitalization across the study region and explored the combined effect of exposure to ambient ozone and air toxics on asthma hospitalization. Asthma hospitalization hot spots and clusters were mostly not located on zip codes with reported high quantities of total air releases of chemical pollutants. There was no significant interaction between ambient ozone exposure and toxic air releases relative to asthma hospitalization. The major predictor of asthma hospitalization was season, with hospitalization rate per 10,000 people for asthma being highest in winter period when ozone levels are usually lowest.
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Affiliation(s)
- Nnamdi C Nnoli
- a Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health , The University of Texas Health Science Center at Houston , Houston , Texas , USA
| | - Stephen H Linder
- b Department of Management Policy and Community Health, School of Public Health , The University of Texas Health Science Center at Houston , Houston , Texas , USA
- c Institute of Health Policy, School of Public Health , The University of Texas Health Science Center at Houston , Houston , Texas , USA
| | - Mary A Smith
- a Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health , The University of Texas Health Science Center at Houston , Houston , Texas , USA
| | - Gretchen L Gemeinhardt
- b Department of Management Policy and Community Health, School of Public Health , The University of Texas Health Science Center at Houston , Houston , Texas , USA
| | - Kai Zhang
- a Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health , The University of Texas Health Science Center at Houston , Houston , Texas , USA
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Szyszkowicz M, Kousha T, Castner J, Dales R. Air pollution and emergency department visits for respiratory diseases: A multi-city case crossover study. ENVIRONMENTAL RESEARCH 2018; 163:263-269. [PMID: 29459308 DOI: 10.1016/j.envres.2018.01.043] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/27/2018] [Accepted: 01/28/2018] [Indexed: 05/23/2023]
Abstract
Increasing evidence suggests that ambient air pollution is a major risk factor for both acute and chronic respiratory disease exacerbations and emergencies. The objective of this study was to determine the association between ambient air pollutants and emergency department (ED) visits for respiratory conditions in nine districts across the province of Ontario in Canada. Health, air pollutant (PM2.5, NO2, O3, and SO2), and meteorological data were retrieved from April 2004 to December 2011. Respiratory diseases were categorized as: chronic obstructive pulmonary disease (COPD, including bronchiectasis) and acute upper respiratory diseases. A case-crossover design was used to test the associations between ED visits and ambient air pollutants, stratified by sex and season. For COPD among males, positive results were observed for NO2 with lags of 3-6 days, for PM2.5 with lags 1-8, and for SO2 with lags of 4-8 days. For COPD among females, positive results were observed for O3 with lags 2-4 days, and for SO2 among lags of 3-6 days. For upper respiratory disease emergencies among males, positive results were observed for NO2 (lags 5-8 days), for O3, (lags 0-6 days), PM2.5 (all lags), and SO2 (lag 8), and among females, positive results were observed for NO2 for lag 8 days, for O3, PM2.5 among all lags. Our study provides evidence of the associations between short-term exposure to air pollution and increased risk of ED visits for upper and lower respiratory diseases in an environment where air pollutant concentrations are relatively low.
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Affiliation(s)
| | - Termeh Kousha
- Population Studies Division, Health Canada, Ottawa, Canada; Department of Mathematics and Statistics, University of Ottawa, Ottawa, Canada.
| | | | - Robert Dales
- Population Studies Division, Health Canada, Ottawa, Canada; University of Ottawa and The Ottawa Hospital Research Institute, Canada.
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Castner J, Guo L, Yin Y. Ambient air pollution and emergency department visits for asthma in Erie County, New York 2007-2012. Int Arch Occup Environ Health 2017; 91:205-214. [PMID: 29043427 DOI: 10.1007/s00420-017-1270-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 10/05/2017] [Indexed: 12/12/2022]
Abstract
PURPOSE 8% of the US population has asthma. Air pollution is linked to exacerbation in susceptible individuals. The objective was to identify air pollutants that increased the risk of asthma emergency department visits during a time wherein a polluting factory was criminally convicted, changing local air pollutant levels. METHODS An ecological time-series design used a daily count of asthma emergency visits from 2007 to 2012 as the dependent variable. Independent variables air pollutants (NO2, PM2.5 CO, and O3), controlling for meteorological conditions, were analyzed using time-series and Poisson GLM models. RESULTS 76,651 emergency asthma visits were included with an average of 35 visits per day (SD = 9.2, range 11-80) in a stationary time series. Increased visit volume in fall and spring had no associations to the air pollutants. Associations between individual air pollutants occurred in otherwise low-volume months for asthma emergency visits. The strongest relationship was an 11.6% increase in the asthma emergency visit rate during the month of June. In monthly groupings that removed most of the autumn and spring months, O3, PM2.5, CO, and NO2 were associated with 5, 4, 2, and 2% increases in asthma emergency visits, respectively. CO was the only pollutant with a negative association with asthma emergency visits, occurring in the month of April. CONCLUSIONS Pollutants NO2, PM2.5 CO, and O3 were associated with increased emergency asthma visits in some, but not all months of the year. Air pollution's impact on asthma emergencies may be masked by other, more influential seasonal triggers, such as infections or allergies.
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Affiliation(s)
- Jessica Castner
- University at Buffalo, Buffalo, NY, USA. .,Heilbrunn Family Center for Research Nursing Scholar, Rockefeller University, New York, NY, USA.
| | | | - Yong Yin
- Department of Economics, College of Arts and Sciences, University at Buffalo, Buffalo, NY, USA
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Peconi J, Macey S, Rodgers S, Russell I, Snooks H, Watkins A. Advice given by NHS Direct in Wales: do deprived patients get more urgent decisions? Study of routine data. J Epidemiol Community Health 2017; 71:jech-2017-208978. [PMID: 28733459 PMCID: PMC5561357 DOI: 10.1136/jech-2017-208978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/11/2017] [Accepted: 06/08/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND In the UK, National Health Service Direct Wales (NHSDW) uses computerised decision support software to advise patients on appropriate care. However, the effect of deprivation on the advice given is not known. We aimed to estimate the effect of deprivation on advice given by nurses in NHSDW adjusting for confounding variables. METHODS We included 400 000 calls to NHSDW between January 2002 and June 2004. We used logistic regression to model the effect of deprivation on advice given by nurses in response to calls seeking advice or information. We analysed two outcomes: receiving advice to phone 999 emergency care rather than to seek other care and receiving advice to seek care face to face rather than self-care. RESULTS After adjustment for covariates, an increase in deprivation from one-fifth of the distribution to the next fifth increased by 13% the probability that those calling for advice rather than information received advice to phone 999 (OR 1.127; 95% CI from 1.113 to 1.143). Deprivation increased the corresponding probability of being advised to seek care face to face rather than self-care by 5% (OR 1.049; 95% CI from 1.041 to 1.058) within advice calls and by 3% (OR 1.034; 95% CI from 1.022 to 1.047) within information calls. CONCLUSIONS Deprivation increased the chance of receiving more urgent advice, particularly advice to call 999. While our dataset may underestimate the 'need' of deprived patients, it yields no evidence of major inequity in advice given to these patients.
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Affiliation(s)
- Julie Peconi
- Swansea University Medical School, Institute of Life Sciences 2 (ILS2), Swansea University, Swansea, UK
| | - Steven Macey
- Action on Smoking and Health (ASH) Wales, Cardiff, UK
| | - Sarah Rodgers
- Swansea University Medical School, Institute of Life Sciences 2 (ILS2), Swansea University, Swansea, UK
| | - Ian Russell
- Swansea University Medical School, Institute of Life Sciences 2 (ILS2), Swansea University, Swansea, UK
| | - Helen Snooks
- Swansea University Medical School, Institute of Life Sciences 2 (ILS2), Swansea University, Swansea, UK
| | - Alan Watkins
- Swansea University Medical School, Institute of Life Sciences 2 (ILS2), Swansea University, Swansea, UK
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O’ Lenick CR, Chang HH, Kramer MR, Winquist A, Mulholland JA, Friberg MD, Sarnat SE. Ozone and childhood respiratory disease in three US cities: evaluation of effect measure modification by neighborhood socioeconomic status using a Bayesian hierarchical approach. Environ Health 2017; 16:36. [PMID: 28381221 PMCID: PMC5382444 DOI: 10.1186/s12940-017-0244-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 03/24/2017] [Indexed: 05/22/2023]
Abstract
BACKGROUND Ground-level ozone is a potent airway irritant and a determinant of respiratory morbidity. Susceptibility to the health effects of ambient ozone may be influenced by both intrinsic and extrinsic factors, such as neighborhood socioeconomic status (SES). Questions remain regarding the manner and extent that factors such as SES influence ozone-related health effects, particularly across different study areas. METHODS Using a 2-stage modeling approach we evaluated neighborhood SES as a modifier of ozone-related pediatric respiratory morbidity in Atlanta, Dallas, & St. Louis. We acquired multi-year data on emergency department (ED) visits among 5-18 year olds with a primary diagnosis of respiratory disease in each city. Daily concentrations of 8-h maximum ambient ozone were estimated for all ZIP Code Tabulation Areas (ZCTA) in each city by fusing observed concentration data from available network monitors with simulations from an emissions-based chemical transport model. In the first stage, we used conditional logistic regression to estimate ZCTA-specific odds ratios (OR) between ozone and respiratory ED visits, controlling for temporal trends and meteorology. In the second stage, we combined ZCTA-level estimates in a Bayesian hierarchical model to assess overall associations and effect modification by neighborhood SES considering categorical and continuous SES indicators (e.g., ZCTA-specific levels of poverty). We estimated ORs and 95% posterior intervals (PI) for a 25 ppb increase in ozone. RESULTS The hierarchical model combined effect estimates from 179 ZCTAs in Atlanta, 205 ZCTAs in Dallas, and 151 ZCTAs in St. Louis. The strongest overall association of ozone and pediatric respiratory disease was in Atlanta (OR = 1.08, 95% PI: 1.06, 1.11), followed by Dallas (OR = 1.04, 95% PI: 1.01, 1.07) and St. Louis (OR = 1.03, 95% PI: 0.99, 1.07). Patterns of association across levels of neighborhood SES in each city suggested stronger ORs in low compared to high SES areas, with some evidence of non-linear effect modification. CONCLUSIONS Results suggest that ozone is associated with pediatric respiratory morbidity in multiple US cities; neighborhood SES may modify this association in a non-linear manner. In each city, children living in low SES environments appear to be especially vulnerable given positive ORs and high underlying rates of respiratory morbidity.
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Affiliation(s)
- Cassandra R. O’ Lenick
- Department of Environmental Health, Rollins School of Public Health, Emory University, Second Floor, Claudia Nance Rollins Building, Rm. 2030 B, 1518 Clifton Road NE, Atlanta, GA 30322 USA
| | - Howard H. Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Michael R. Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Andrea Winquist
- Department of Environmental Health, Rollins School of Public Health, Emory University, Second Floor, Claudia Nance Rollins Building, Rm. 2030 B, 1518 Clifton Road NE, Atlanta, GA 30322 USA
| | - James A. Mulholland
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA USA
| | - Mariel D. Friberg
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA USA
| | - Stefanie Ebelt Sarnat
- Department of Environmental Health, Rollins School of Public Health, Emory University, Second Floor, Claudia Nance Rollins Building, Rm. 2030 B, 1518 Clifton Road NE, Atlanta, GA 30322 USA
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Dimakopoulou K, Grivas G, Samoli E, Rodopoulou S, Spyratos D, Papakosta D, Karakatsani A, Chaloulakou A, Katsouyanni K. Determinants of personal exposure to ozone in school children. Results from a panel study in Greece. ENVIRONMENTAL RESEARCH 2017; 154:66-72. [PMID: 28039827 DOI: 10.1016/j.envres.2016.12.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/20/2016] [Accepted: 12/21/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND In the wider framework of the RESPOZE (ReSPiratory effects of OZone Exposure in Greek children) panel study, we investigated possible determinants of O3 exposure of school children, measured with personal passive samplers, in Athens and Thessaloniki, Greece. METHODS Personal exposure to O3 was measured for five weeks spread along the academic year 2013-14, in 186 school children in Athens and Thessaloniki, Greece. At the same time, at-school outdoor measurements were performed and ambient levels of 8-h daily maximum O3 from fixed sites were collected. We also collected information on lifestyle and housing characteristics through an extended general questionnaire (GQ) and each participant completed daily time activity diaries (TADs) during the study period. RESULTS Mean outdoor concentrations were higher during the warmer months, in the suburbs of the cities and in Athens. Personal exposure concentrations were significantly lower compared to outdoor. Daily levels of at-school outdoor and ambient levels of O3 from fixed sites were significant determinants of personal exposure to O3. For a 10μg/m3 increase in at-school outdoor O3 concentrations and PM10 measurements a 20.9% (95% CI: 13%, 28%) increase in personal exposure to O3 was found. For a half an hour more spent in transportation an average increase of 7% (95% CI: 0.3%, 14.6%) in personal exposure to O3 was observed. Among other possible determinants, time spent in transportation (TAD variable) and duration of open windows were the ones associated with personal O3 exposure levels. CONCLUSIONS Our results support the use of outdoor and ambient measurements from fixed sites in epidemiological studies as a proxy of personal exposure to O3, but this has to be calibrated taking into account personal measurements and time-activity patterns.
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Affiliation(s)
- Konstantina Dimakopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, 75, Mikras Asias Street, 115 27 Athens, Greece
| | - Georgios Grivas
- School of Chemical Engineering, National Technical University of Athens, Athens, Greece
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, 75, Mikras Asias Street, 115 27 Athens, Greece
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, 75, Mikras Asias Street, 115 27 Athens, Greece
| | - Dionisis Spyratos
- Pulmonary Department, G. Papanikolaou Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Despoina Papakosta
- Pulmonary Department, G. Papanikolaou Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anna Karakatsani
- 2nd Pulmonary Department, "ATTIKON" University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, 75, Mikras Asias Street, 115 27 Athens, Greece; Department of Primary Care & Public Health Sciences and MRC-PHE Centre for Environment and Health, King's College London, London, UK.
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Gorai AK, Tchounwou PB, Tuluri F. Association between Ambient Air Pollution and Asthma Prevalence in Different Population Groups Residing in Eastern Texas, USA. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:378. [PMID: 27043587 PMCID: PMC4847040 DOI: 10.3390/ijerph13040378] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 12/30/2015] [Accepted: 01/11/2016] [Indexed: 11/16/2022]
Abstract
Air pollution has been an on-going research focus due to its detrimental impact on human health. However, its specific effects on asthma prevalence in different age groups, genders and races are not well understood. Thus, the present study was designed to examine the association between selected air pollutants and asthma prevalence in different population groups during 2010 in the eastern part of Texas, USA.The pollutants considered were particulate matter (PM2.5 with an aerodynamic diameter less than 2.5 micrometers) and surface ozone. The population groups were categorized based on age, gender, and race. County-wise asthma hospital discharge data for different age, gender, and racial groups were obtained from Texas Asthma Control Program, Office of Surveillance, Evaluation and Research, Texas Department of State Health Services. The annual means of the air pollutants were obtained from the United States Environmental Protection Agency (U.S. EPA)'s air quality system data mart program. Pearson correlation analyzes were conducted to examine the relationship between the annual mean concentrations of pollutants and asthma discharge rates (ADR) for different age groups, genders, and races. The results reveal that there is no significant association or relationship between ADR and exposure of air pollutants (PM2.5, and O₃). The study results showed a positive correlation between PM2.5 and ADR and a negative correlation between ADR and ozone in most of the cases. These correlations were not statistically significant, and can be better explained by considering the local weather conditions. The research findings facilitate identification of hotspots for controlling the most affected populations from further environmental exposure to air pollution, and for preventing or reducing the health impacts.
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Affiliation(s)
- Amit Kr Gorai
- Department of Mining Engineering, National Institute of Technology, Rourkela, Odisha 769008, India.
| | - Paul B Tchounwou
- NIH/NIMHD RCMI Center for Environmental Health, College of Science, Engineering and Technology, Jackson State University, Jackson, MS 39217, USA.
| | - Francis Tuluri
- Department of Industrial System and Technology, Jackson State University, Jackson, MS 39217, USA.
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Castner J, Gittere S, Seo JY. Criteria Air Pollutants and Emergency Nursing. J Emerg Nurs 2015; 41:186-92. [DOI: 10.1016/j.jen.2014.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 08/14/2014] [Accepted: 08/17/2014] [Indexed: 11/26/2022]
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Sheffield PE, Zhou J, Shmool JLC, Clougherty JE. Ambient ozone exposure and children's acute asthma in New York City: a case-crossover analysis. Environ Health 2015; 14:25. [PMID: 25889205 PMCID: PMC4373115 DOI: 10.1186/s12940-015-0010-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 02/26/2015] [Indexed: 05/26/2023]
Abstract
BACKGROUND Childhood asthma morbidity has been associated with ambient ozone in case-crossover studies. Varying effects of ozone by child age and sex, however, have been less explored. METHODS This study evaluates associations between ozone exposure and asthma emergency department visits and hospitalizations among boys and girls aged 5-17 years in New York City for the 2005-2011 warm season period. Time-stratified case-crossover analysis was conducted and, for comparison, time-series analysis controlling for season, day-of-week, same-day and delayed effects of temperature and relative humidity were also performed. RESULTS We found associations between ambient ozone levels and childhood asthma emergency department visits and hospitalizations in New York City, although the relationships varied among boys and girls and by age group. For an increase of interquartile range (0.013 ppm) in ozone, there was a 2.9-8.4% increased risk for boys and 5.4-6.5% for girls in asthma emergency department visits; and 8.2% increased risk for girls in hospitalizations. Among girls, we observed stronger associations among older children (10-13 and 14-17 year age groups). We did not observe significant modification by age for boys. Boys exhibited a more prompt response (lag day 1) to ozone than did girls (lag day 3), but significant associations for girls were retained longer, through lag day 6. CONCLUSIONS Our study indicates significant variance in associations between short-term ozone concentrations and asthma events by child sex and age. Differences in ozone response for boys and girls, before and after puberty, may point towards both social (gendered) and biological (sex-linked) sources of effect modification.
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Affiliation(s)
- Perry Elizabeth Sheffield
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl., Box 1057, DPM, New York, NY, 10029, USA.
| | - Jiang Zhou
- Department of Environmental and Occupational Health, University of Pittsburgh Graduate School of Public Health, 100 Technology Drive, Pittsburgh, PA, 15219, USA.
| | - Jessie Loving Carr Shmool
- Department of Environmental and Occupational Health, University of Pittsburgh Graduate School of Public Health, 100 Technology Drive, Pittsburgh, PA, 15219, USA.
| | - Jane Ellen Clougherty
- Department of Environmental and Occupational Health, University of Pittsburgh Graduate School of Public Health, 100 Technology Drive, Pittsburgh, PA, 15219, USA.
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Ambient ozone and emergency department visits due to lower respiratory condition. Int J Occup Med Environ Health 2014; 27:50-9. [PMID: 24464442 DOI: 10.2478/s13382-014-0229-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 12/16/2013] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Ambient ozone (O3) exposure is associated with a variety of health conditions. The objective of this study was to examine the effect of increased daily concentrations of ozone on emergency department (ED) visits due to lower respiratory diseases (LRD), such as acute or chronic bronchitis, in Edmonton, Canada. MATERIALS AND METHODS Data concerning 10 years (1992-2002) were obtained from 5 Edmonton hospital Emergency Departments. Odds ratios (ORs) for ED visits associated with the increased ozone levels were calculated employing a case-crossover technique with a time-stratified strategy to define controls. In the constructed conditional logistic regression models, adjustments were made for daily number of influenza ED visits and weather variables using natural splines. ORs and their 95% confidence intervals (95% CI) were reported in relation to an increase in the interquartile range (IQR = 17.9 ppb) of the ground-level ozone. RESULTS Overall, 48 252 ED visits due to LRD were identified, of which 53% were made by males. The presentations peaked in December (12%) and February (11.7%) and were the lowest in August (5.6%). Positive and statistically significant results were obtained for acute bronchitis: for same day (OR = 1.09, 95% CI: 1.05-1.13, lag 0) and for lag 2, lag 3-7 and 9 days; for chronic bronchitis: for lag 6, 7, and lag 9 days (OR = 1.11, 95% CI: 1.05-1.18, lag 9). For all ED visits for LRD, lag 0, lag 1, and lag 3-9 days showed positive and statistically significant associations (OR = 1.06, 95% CI: 1.03-1.09, lag 0). CONCLUSIONS These findings support the hypothesis concerning positive associations between ozone and the ED visits due to LRD.
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Berman JD, Fann N, Hollingsworth JW, Pinkerton KE, Rom WN, Szema AM, Breysse PN, White RH, Curriero FC. Health benefits from large-scale ozone reduction in the United States. ENVIRONMENTAL HEALTH PERSPECTIVES 2012; 120:1404-10. [PMID: 22809899 PMCID: PMC3491929 DOI: 10.1289/ehp.1104851] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 06/29/2012] [Indexed: 05/07/2023]
Abstract
BACKGROUND Exposure to ozone has been associated with adverse health effects, including premature mortality and cardiopulmonary and respiratory morbidity. In 2008, the U.S. Environmental Protection Agency (EPA) lowered the primary (health-based) National Ambient Air Quality Standard (NAAQS) for ozone to 75 ppb, expressed as the fourth-highest daily maximum 8-hr average over a 24-hr period. Based on recent monitoring data, U.S. ozone levels still exceed this standard in numerous locations, resulting in avoidable adverse health consequences. OBJECTIVES We sought to quantify the potential human health benefits from achieving the current primary NAAQS standard of 75 ppb and two alternative standard levels, 70 and 60 ppb, which represent the range recommended by the U.S. EPA Clean Air Scientific Advisory Committee (CASAC). METHODS We applied health impact assessment methodology to estimate numbers of deaths and other adverse health outcomes that would have been avoided during 2005, 2006, and 2007 if the current (or lower) NAAQS ozone standards had been met. Estimated reductions in ozone concentrations were interpolated according to geographic area and year, and concentration-response functions were obtained or derived from the epidemiological literature. RESULTS We estimated that annual numbers of avoided ozone-related premature deaths would have ranged from 1,410 to 2,480 at 75 ppb to 2,450 to 4,130 at 70 ppb, and 5,210 to 7,990 at 60 ppb. Acute respiratory symptoms would have been reduced by 3 million cases and school-loss days by 1 million cases annually if the current 75-ppb standard had been attained. Substantially greater health benefits would have resulted if the CASAC-recommended range of standards (70-60 ppb) had been met. CONCLUSIONS Attaining a more stringent primary ozone standard would significantly reduce ozone-related premature mortality and morbidity.
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Affiliation(s)
- Jesse D Berman
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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