Air Quality and Pediatric Emergency Room Visits for Asthma and Atlanta, Georgia

Abstract

Pediatric emergency room visits for asthma were studied in relation to air quality indices in a spatio-temporal investigation of approximately 130,000 visits (approximately 6,000 for asthma) to the major emergency care centers in Atlanta, Georgia, during the summers of 1993-1995. Generalized estimating equations, logistic regression, and Bayesian models were fitted to the data. In logistic regression models comparing estimated exposures of asthma cases with those of the nonasthma patients, controlling for temporal and demographic covariates and using residential zip code to link patients to spatially resolved ozone levels, the estimated relative risk per 20 parts per billion (ppb) increase in the maximum 8-hour ozone level was 1.04 (p < 0.05). The estimated relative risk for particulate matter less than or equal to 10 microm in aerodynamic diameter (PM10) was 1.04 per 15 microg/m3 (p < 0.05). Exposure-response trends (p < 0.01) were observed for ozone (>100 ppb vs. <50 ppb: odds ratio = 1.23, p = 0.003) and PM10 (>60 microg/m3 vs. <20 microg/m3: odds ratio = 1.26, p = 0.004). In models with ozone and PM10, both terms became nonsignificant because of collinearity of the variables (r= 0.75). The other analytical approaches yielded consistent findings. This study supports accumulating evidence regarding the relation of air pollution to childhood asthma exacerbation.

Interim results of the study of particulates and health in Atlanta (SOPHIA)

“…The respiratory case groups are: asthma (493 ), wheezing ( 786.09 ), chronic obstructive pulmonary disease ( COPD;491,492,496 ), lower respiratory infection ( 466.1, 480, 481, 482, 483, 484, 485, 486) , and all respiratory diseases combined (460 ± 466, 477, 480 ±486, 491, 492, 493, 496, 786.09 ). For the asthma outcome, we are restricting the case definition to adults in order to make the analysis independent of a previous study of pediatric asthma that covered part of this study period at some of the same EDs ( Tolbert et al, 2000 ). The referent group is composed of all visits excluding the cardiorespiratory groupings defined above.…”

“…A number of epidemiologic studies have shown a positive association between ambient levels of particulate matter ( PM) and various cardiorespiratory outcomes using mortality, hospital admissions, and emergency department ( ED ) admissions data (e.g., Thurston et al, 1994;Pope, 1996;Lipsett et al, 1997;Poloniecki et al, 1997;Schwartz, 1997;Schwartz et al, 1993Schwartz et al, , 1996Prescott et al, 1998;Zmirou et al, 1998;Burnett et al, 1999;Tolbert et al, 2000;see USEPA, 1996 for review ). Because PM is a heterogeneous mixture that varies in composition temporally and spatially, there is a need to identify agents within this mixture that may be responsible for the observed associations.…”

Use of an index to reflect the aggregate burden of long-term exposure to criteria air pollutants in the United States.

“…Increased morbidity has been found to be associated with long-term exposure to particulate matter, for decreased lung function (37,38), increased respiratory symptoms or illness (39)(40)(41)(42)(43)(44)(45)(46), increased symptoms in children with asthma (47), increased hospitalizations or emergency room visits for persons with asthma (48,49), and low birth weight (50)(51)(52). Investigators studying children's absences from school, lung function, and respiratory symptoms report similar results (25,53).…”

Ambient hydrogen sulfide, total reduced sulfur, and hospital visits for respiratory diseases in northeast Nebraska, 1998–2000

“…Daily counts of hospital visits for respiratory diseases or symptoms (International Classification of Diseases, 9th revision, ICD-9: 460-519.9 or 786-786.9) and digestive system diseases or symptoms (ICD-9: 520-579.9 or 787-787.9) between January 1, 1998 and May 31, 2000 were extracted from the computerized billing systems of the two local hospitals. For this study, a patient was categorized as an asthma case if either the primary or secondary ICD-9 codes were 493-493.9 for ''asthma'', 519.1 that includes ''reactive airway disease'', or 786.09 for ''wheezing'' (Tolbert et al, 2000).…”