Air Pollution and Emergency Department Visits for Otitis Media: A Case-Crossover Study in Edmonton, Canada

Zemek, Roger; Szyszkowicz, Mieczysław; Rowe, Brian H.

doi:10.1289/ehp.0901675

Cited by 57 publications

(61 citation statements)

References 24 publications

(41 reference statements)

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“…The results included in this work are not meant to represent scientific findings on ED visits, but are presented as an illustrative example for the use of the presented statistical method: if other accepted methods provide similar results for associations between pollution and health, this strengthens the viability of the chained cluster approach. In addition, the considered in the study data set has been used in a previous study [8] and was found to be robust and interesting.…”

Section: Methodsmentioning

confidence: 99%

“…In our study of mortality we used the same day exposure (lag 0) for ozone, as this lag was found to have a high association in previous studies. In Edmonton (perinatal ED visits) we considered 3 ambient air pollutants (see [8] for a full description of air pollutants in Edmonton), i.e., ozone, nitrogen dioxide (NO 2 ) and particulate matter (PM 2.5 , no greater than 2.5 microns in diameter). These 3 pollutants have been shown by Zemek et al [8] to have a significant association with otitis media, so considering their association with perinatal conditions is reasonable, and additionally have been combined to define a risk index known as the Air Quality Health Index (AQHI) [15].…”

Section: Methodsmentioning

confidence: 99%

“…The mortality data have been used in a number of other studies under the banner of the Air Health Indicator project [6,7] and constitute a robust and well-understood data set. The data for ED visits were used as example data for an illustrative purpose only, with no claims as to biological viability, and are an extension of the data considered in the study of Zemek et al [8]. We considered the daily counts of health events (number of deaths, number of ED visits) as health outcome measurements.…”

Section: Air Pollution Datamentioning

confidence: 99%

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The use of chained two-point clusters for the examination of associations of air pollution with health conditions

Szyszkowicz

Burr

2016

Int J Occup Med Environ Health

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Objectives: There are a few accepted and intensively applied statistical methods used to study associations of ambient air pollution with health conditions. Among the most popular methods applied to assess short term air health effects are case-crossover (using events) and time-series methodologies (using counts). A few other techniques for studying counts of events have been proposed, including the Generalized Linear Mixed Models (GLMM). One suggested GLMM technique uses cluster structures based on natural embedded hierarchies: days are nested in the days of a week (dow), which, in turn, are nested in months and months in years (< dow, month, years >). Material and Methods: In this study the authors considered clusters with hierarchical structures in a form of < dow, 14-days, year >, where the 14-days hierarchy determines 7 clusters composed of 2 days (the same days) of a week (2 Mondays, 2 Tuesdays, etc.), in 1 year. In this work the authors proposed hierarchical chained clusters in which 2 days of a week are grouped as follows: (first, second), (second, third), (third, fourth) and so on. Such an approach allows determination of an additional series of the slopes on the clusters (second, third), (fourth, fifth), etc., i.e., estimation of the coefficients for other configurations of air pollutant levels. The authors considered a series of 2 point chained clusters covering a year. In such a construction each cluster has one common data point (day) with another one. Results: The authors estimated coefficients (slopes) related to the ambient ozone exposure (mortality) and to 3 selected air pollutants (particulate matter, nitrogen dioxide and ozone) combined into index and considered as health risk exposure (emergency department (ED) visits). The generated results were compared to the estimations obtained from the time-series method and the time-stratified case-crossover method applied to the same data. Conclusions: The proposed statistical method, based on the chained hierarchical clusters (< dow, 14-days, year >), generated results with shorter confidence intervals than the other methods.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Air Pollution Datamentioning

confidence: 99%

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The use of chained two-point clusters for the examination of associations of air pollution with health conditions

Szyszkowicz

Burr

2016

Int J Occup Med Environ Health

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“…Ozone is absorbed by both upper and lower respiratory tract, and is a power ful oxidant that can damage respiratory tract, causing inflammation and irritation. Previous work has identi fied ozone levels as being associated with a variety of ED respiratory [1][2][3][4] and nonrespiratory presentations such as otitis media [5], conjunctivitis, skin conditions [6] and cellulitis [7,8].…”

Section: Methodsmentioning

confidence: 99%

Ambient ozone and emergency department visits due to lower respiratory condition

Kousha¹,

Rowe²

2014

International Journal of Occupational Medicine and Environmental Health

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Objectives: Ambient ozone (O 3 ) 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 respi ratory diseases (LRD), such as acute or chronic bronchitis, in Edmonton, Canada. Materials and Methods: Data concer ning 10 years (1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(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 num ber 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: Over all, 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 bronchi tis: 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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“…[23] A detailed description of air pollutant and weather measurements, monitor distribution, and correlations among monitors has been previously reported. [24] Statistical Analysis. We applied a case crossover study design, which is an adaptation of the case-control study whereby cases serve as their own controls.…”

Section: Phase 1: Epidemiological Studiesmentioning

confidence: 99%

1055 Non-Specific Abdominal Pain and Air Pollution: A Novel Association

Kaplan¹,

Rowe²,

Storr³

et al. 2009

Gastroenterology

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Air Pollution and Emergency Department Visits for Otitis Media: A Case-Crossover Study in Edmonton, Canada

Cited by 57 publications

References 24 publications

The use of chained two-point clusters for the examination of associations of air pollution with health conditions

The use of chained two-point clusters for the examination of associations of air pollution with health conditions

Ambient ozone and emergency department visits due to lower respiratory condition

1055 Non-Specific Abdominal Pain and Air Pollution: A Novel Association

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