Effects of Fine Particulate Matter and Its Components on Emergency Room Visits for Pediatric Pneumonia: A Time-Stratified Case-Crossover Study

Abstract

Pneumonia, one of the important causes of death in children, may be induced or aggravated by particulate matter (PM). Limited research has examined the association between PM and its constituents and pediatric pneumonia-related emergency department (ED) visits. Measurements of PM2.5, PM10, and four PM2.5 constituents, including elemental carbon (EC), organic carbon (OC), nitrate, and sulfate, were extracted from 2007 to 2010 from one core station and two satellite stations in Kaohsiung City, Taiwan. Furthermore, the medical records of patients under 17 years old who had visited the ED in a medical center and had a diagnosis of pneumonia were collected. We used a time-stratified, case-crossover study design to estimate the effect of PM. The single-pollutant model demonstrated interquartile range increase in PM2.5, PM10, nitrate, OC, and EC on lag 3, which increased the risk of pediatric pneumonia by 18.2% (95% confidence interval (Cl), 8.8‒28.4%), 13.1% (95% CI, 5.1‒21.7%), 29.7% (95% CI, 16.4‒44.5%), 16.8% (95% CI, 4.6‒30.4%), and 14.4% (95% Cl, 6.5‒22.9%), respectively. After PM2.5, PM10, and OC were adjusted for, nitrate and EC remained significant in two-pollutant models. Subgroup analyses revealed that nitrate had a greater effect on children during the warm season (April to September, interaction p = 0.035). In conclusion, pediatric pneumonia ED visit was related to PM2.5 and its constituents. Moreover, PM2.5 constituents, nitrate and EC, were more closely associated with ED visits for pediatric pneumonia, and children seemed to be more susceptible to nitrate during the warm season.

Associations between air pollutant and pneumonia and asthma requiring hospitalization among children aged under 5 years in Ningbo, 2015–2017

“…In addition, PMs increase susceptibility to infection via suppression of immunity ( 12 ). Effects of PM on pneumonia have also been widely studied ( 48 , 58 , 59 ). One systematic meta-analysis concluded that for each 10 mg/m 3 increase in PM 2.5 and PM 10 , short-term impacts on hospitalization for pediatric pneumonia in children were ~1.8% (95% CI : 1.005, 1.031) and 1.5% (95% CI : 1.006, 1.024), with PM 2.5 second only to SO 2 in terms of influence on risk ( 48 ).…”

“…A study performed in Qingdao, China reported that an increase in interquartile spacing between PM 2.5 and PM 10 was associated with a significant increase in risk of hospitalization for pneumonia in children under 4 years of age, at 7.5% (95% CI : 1.017, 1.136) and 10.1% (95% CI : 1.037, 1.169), respectively ( 58 ). Taiwanese studies have provided higher estimates, reporting increased interquartile spacing of PM 2.5 and PM 10 at lag3 to increase the risk for emergency department admission for children suffering pneumonia by 18.2 (95% CI : 1.088, 1.284) and 13.1% (95% CI : 1.051, 1.217) ( 59 ). Moreover, the adverse effects of PM on pediatric hospitalization for respiratory diseases such as asthma and bronchiolitis were also studied in Brazil ( 60 ) and the United States ( 61 ).…”

Ambient Air Pollution and Risk for Stroke Hospitalization: Impact on Susceptible Groups

“…Air pollution has been associated with many adverse health effects that include asthma, pneumonia, and acute exacerbation of chronic obstructive pulmonary disease [ 22 , 24 , 25 ]. Previous studies have also revealed the impact of air pollution on cardiovascular diseases, such as myocardial infarction, acute coronary syndrome, and stroke [ 26 , 27 , 28 , 29 ].…”

“…Temperature and relative humidity were included as confounding factors in the model. Potential nonlinear relationships between air temperature, humidity, and stroke hospitalization were determined using the Akaike information criterion (AIC) [ 21 , 22 ]. The ORs were calculated based on the per interquartile range (IQR) increments for each particulate and gaseous pollutant.…”

Risk Assessment of NH3 and H2S in Coastal and Complex Sectors in Egypt by Using AirQ+ Software

“…diseases [1,[10][11][12][13][14]. Toxicological studies have also found that exposure to air pollutants might induce airway inflammation and elevated inflammatory biomarkers [15][16][17][18][19][20][21].…”