Impact of air pollution on educational attainment for respiratory health treated students: A cross sectional data linkage study

INTRODUCTION

There is some evidence that exam results are worse when students are acutely exposed to air pollution. Studies investigating the association between air pollution and academic attainment have been constrained by small sample sizes.

METHODS

Cross sectional educational attainment data (2009-2015) from students aged 15-16 years in Cardiff, Wales were linked to primary health care data, modelled air pollution and measured pollen data, and analysed using multilevel linear regression models. Annual cohort, school and individual level confounders were adjusted for in single and multi-pollutant/pollen models. We stratified by treatment of asthma and/or Seasonal Allergic Rhinitis (SAR).

RESULTS

A unit (10μg/m3) increase of short-term exposure to NO2 was associated with 0.044 (95% CI: -0.079, -0.008) reduction of standardised Capped Point Score (CPS) after adjusting for individual and household risk factors for 18,241 students. This association remained statistically significant after controlling for other pollutants and pollen. There was no association of PM2.5, O3, or Pollen with standardised CPS remaining after adjustment. We found no evidence that treatment for asthma or SAR modified the observed NO2 effect on educational attainment.

CONCLUSION

Our study showed that short-term exposure to traffic-related air pollution, specifically NO2, was associated with detrimental educational attainment for students aged 15-16. Longitudinal investigations in different settings are required to confirm this possible impact and further work may uncover the long-term economic implications, and degree to which impacts are cumulative and permanent.

The impact of primary care management and comorbidities of COPD on length of hospital stay

IntroductionHealth Resource Groups (HRGs) are bundles of care that absorb similar financial resources. Variations in hospital length of stay (LOS) of patients with the same admission diagnosis and assigned HRG may reflect differences in pre-admission primary care services received by patients. Objectives and ApproachWe investigated whether within HRGs, variations of LOS of chronic obstructive pulmonary disease (COPD) admissions were associated with differences in COPD management services received in primary care. Individual-level primary and secondary care data from the Secure Anonymised Information Linkage (SAIL) databank of Wales was used for admissions in 2015 with high-volume (n>30) HRGs. Effects of selected COPD primary care quality surrogate measures and comorbidities on LOS were analysed using a linear regression model adjusted for a modified Charlson co-morbidity index. The effect of completed pulmonary rehabilitation (PR) was analysed in a separate dataset for the Cwm Taf Health Board. ResultsWe included 77,791 COPD patients, with mean age of 73.4 [SD=11.0], and 51.6% of which were males. Patients who were referred for a PR course prior to admission stayed 0.58 less days (95% CI = [0.18, 0.98], p<0.01), while those who completed a PR course stayed 0.76 less days ([0.25, 1.27], p<0.01). Non-significant associations were found where female patients stayed 0.34 days longer than males ([-0.01, 0.68], p=0.05), patients given flu vaccination stayed 0.39 less days ([-0.07, 0.86], p=0.10), and patients with anxiety diagnosis stayed 0.43 more days ([-0.03, 0.88], p=0.06). Conclusion/ImplicationsLOS for COPD could potentially be reduced with further targeted services provided in primary care. Countries using HRGs with access to linked primary and secondary care data can unlock care insights, enabling live monitoring of the effectiveness of primary care interventions. This approach can be also used for other conditions.

Creating individual level air pollution exposures in an anonymised data safe haven: a platform for evaluating impact on educational attainment

Introduction

There is a lack of evidence on the adverse effects of air pollution on cognition for people with air quality-related health conditions. We propose that educational attainment, as a proxy for cognition, may increase with improved air quality. This study will explore whether asthma and seasonal allergic rhinitis, when exacerbated by acute exposure to air pollution, is associated with educational attainment.

Objective

To describe the preparation of individual and household-level linked environmental and health data for analysis within an anonymised safe haven. Also to introduce our statistical analysis plan for our study: COgnition, Respiratory Tract illness and Effects of eXposure (CORTEX).

Methods

We imported daily air pollution and aeroallergen data, and individual level education data into the SAIL databank, an anonymised safe haven for person-based records. We linked individual-level education, socioeconomic and health data to air quality data for home and school locations, creating tailored exposures for individuals across a city. We developed daily exposure data for all pupils in repeated cross sectional exam cohorts (2009-2015).

Conclusion

We have used the SAIL databank, an innovative, data safe haven to create individual-level exposures to air pollution and pollen for multiple daily home and school locations. The analysis platform will allow us to evaluate retrospectively the impact of air quality on attainment for multiple cross-sectional cohorts of pupils. Our methods will allow us to distinguish between the pollution impacts on educational attainment for pupils with and without respiratory health conditions. The results from this study will further our understanding of the effects of air quality and respiratory-related health conditions on cognition.

Highlights

A tool to improve the efficiency and reproducibility of research using electronic health record databases

BackgroundInterrogation of electronic health record databases often involves time-consuming, manual, repetitive work in developing database queries. We developed a tool to automate this process. MethodsWe identified elementary approaches to query primary care data from the Secure Anonymised Information Linkage databank of Wales. We designed a web-based query builder that allows using combinations of these approaches as ‘building blocks’ to query complex variables. We created an R programme to automatically generate and execute the corresponding Structured Query Language queries. ResultsThe tool allows data extraction using combinations of the following methods: event count (e.g., asthma prescriptions); code/date of earliest/latest event; code/date/value of the event of maximum/minimum value; and frequency of temporally constrained events. Query intervals could be fixed, dynamic, or individualised. The tool integrates with a codeset repository. Data extraction procedures and codesets are saved on a web server as versioned, shareable, and citable objects. ConclusionThis versatile tool allows rapid and complex data extraction with minimal to no programming skills, reduces human errors, and improves research transparency and reproducibility. Funding/SupportHealth and Care Research Wales, ABMU Health Board, AUKCAR (AUK-AC-2012-01), Farr Institute of Health Informatics Research (MR/K006525/1-MR/K007017/1).