Effect of Ambient Air Pollution on Hospital Readmissions among the Pediatric Asthma Patient Population in South Texas: A Case-Crossover Study

Abstract

<jats:p>Few studies have evaluated the association between ambient air pollution and hospital readmissions among children with asthma, especially in low-income communities. This study examined the short-term effects of ambient air pollutants on hospital readmissions for pediatric asthma in South Texas. A time-stratified case-crossover study was conducted using the hospitalization data from a children’s hospital and the air pollution data, including particulate matter 2.5 (PM2.5) and ozone concentrations, from the Centers for Disease Control and Prevention between 2010 and 2014. A conditional logistic regression analysis was performed to investigate the association between ambient air pollution and hospital readmissions, controlling for outdoor temperature. We identified 111 pediatric asthma patients readmitted to the hospital between 2010 and 2014. The single-pollutant models showed that PM2.5 concentration had a significant positive effect on risk for hospital readmissions (OR = 1.082, 95% CI = 1.008–1.162, p = 0.030). In the two-pollutant models, the increased risk of pediatric readmissions for asthma was significantly associated with both elevated ozone (OR = 1.023, 95% CI = 1.001–1.045, p = 0.042) and PM2.5 concentrations (OR = 1.080, 95% CI = 1.005–1.161, p = 0.036). The effects of ambient air pollutants on hospital readmissions varied by age and season. Our findings suggest that short-term (4 days) exposure to air pollutants might increase the risk of preventable hospital readmissions for pediatric asthma patients.</jats:p>

The Effect of Outdoor Environmental Exposure on Readmission Rates for Children and Adolescents with Asthma—A Systematic Review

“…There were six studies [ 9 , 10 , 11 , 12 , 13 , 22 ] using the odds ratio (OR) to assess the likelihood of readmission rate due to outdoor exposure. Findings for these can be found in Table 2 .…”

“…Baek et al (2020) [ 12 ] used seasonal trends; however, they also looked at the effects of air pollutants, particulate matter 2.5 (PM 2.5 ), and ozone (O 3 ). The seasons were divided into a warm season, defined as the months between May and October, or cold season, defined as the months between November and April.…”

“…The air pollutant models were also adjusted for temperature. As Baek et al (2020) [ 13 ] was a substudy of Baek et al (2020) [ 12 ], the exposure is essentially the same; however, the air pollutants were both measured using the daily average prediction from the reliable United States of America environmental protection agency (U.S. EPA) Downscaler model [ 25 ], which were then divided into four categories (quartile 1 (the lowest) to quartile 4 (the highest)). In contrast, Beck et al (2017) [ 17 ] utilised the Health and Environmental Opportunity Index (HEOI) [ 26 ] as the exposure variable.…”

“…Many studies have been undertaken to understand factors that trigger asthma exacerbations requiring admissions; however, to a lesser extent only a handful of studies have explored risk factors of asthma readmission rates. Furthermore, very few studies [ 9 , 10 , 11 , 12 , 13 ] have investigated the impact of outdoor environmental risk factors associated with asthma readmission rates. No study has been undertaken to synthesise the outdoor environmental risk factors on readmission rates.…”

Effects of PM2.5 on Chronic Airway Diseases: A Review of Research Progress

“…To date, studies have confirmed that PM 2.5 is the only compound that is independently related to emergency department visits for asthma patients [56,57]. Moreover, a case-crossing study from South Texas has shown that elevated PM 2.5 concentration increased the risk of readmissions in children with asthma [58]. Wheezing is a primary respiratory symptom to assess exogenous factors that trigger asthma attacks.…”