Evaluation of individual and area-level factors as modifiers of the association between warm-season temperature and pediatric asthma morbidity in Atlanta, GA

Abstract

Introduction Previous studies have found associations between respiratory morbidity and high temperatures; however, few studies have explored associations in potentially sensitive sub-populations. Methods We evaluated individual and area-level factors as modifiers of the association between warm-season (May–Sept.) temperature and pediatric respiratory morbidity in Atlanta. Emergency department (ED) visit data were obtained for children, 5–18 years old, with primary diagnoses of asthma or respiratory disease (diagnoses of upper respiratory infections, bronchiolitis, pneumonia, chronic obstructive pulmonary disease, asthma, or wheeze) in 20-county Atlanta during 1993–2012. Daily maximum temperature (Tmax) was acquired from the automated surface observing station at Atlanta Hartsfield International Airport. Poisson generalized linear models were used to estimate rate ratios (RR) between daily Tmax and asthma or respiratory disease ED visits, controlling for time and meteorology. Tmax effects were estimated for single-day lags of 0–6 days, for 3-, 5-, and 7-day moving averages and modeled with cubic terms to allow for non-linear relationships. Effect modification by individual factors (sex, race, insurance status) and area-level socioeconomic status (SES; ZIP code levels of poverty, education, and the neighborhood deprivation index) was examined via stratification. Results Estimated RRs for Tmax and pediatric asthma ED visits were positive and significant for lag days 1–5, with the strongest single day association observed on lag day 2 (RR=1.06, 95% CI: 1.03, 1.09) for a change in Tmax from 27 °C to 32 °C (25th to 75th percentile). For the moving average exposure periods, associations increased as moving average periods increased. We observed stronger RRs between Tmax and asthma among males compared to females, non-white children compared to white children, children with private insurance compared to children with Medicaid, and among children living in high compared to low SES areas. Associations between Tmax and respiratory disease ED visits were weak and non-significant (p-value > 0.05). Conclusions Results suggest socio-demographic factors (race/ethnicity, insurance status, and area-level SES) may confer vulnerability to temperature-related pediatric asthma morbidity. Our findings of weaker associations among children with Medicaid compared to other health insurance types and among children living in low compared to high SES areas run counter to our belief that children from disadvantaged households or ZIP codes would be more vulnerable to the respiratory effects of temperature. The potential reasons for these unexpected results are explored in the discussion.

Associations between Ambient Fine Particulate Oxidative Potential and Cardiorespiratory Emergency Department Visits

“…Computerized billing records on ED visits were acquired from the Georgia Hospital Association for all 38 nonfederal acute care hospitals with emergency departments in the 20-county Atlanta metropolitan area for the study period ( O’Lenick et al 2017 ; Sarnat et al 2010 ). Patient variables included date of admission, all recorded International Classification of Diseases, Ninth Revision (ICD-9) diagnostic codes, date of birth, sex, race, and five-digit residential ZIP code.…”

Climate Change and Childhood Respiratory Health: A Call to Action for Paediatricians

“…More recently, a study reported lagged effects for temperature-related and paediatric asthma emergency visits, suggesting that children are at risk for increased asthma morbidity when temperatures are high, on average, for several days. In detail, estimated Relative Risks (RRs) for maximum temperatures and asthma emergency visits were positive and significant for lag days 1-5, with the strongest single-day association observed on lag day 2 (RR = 1.06, 95% CI: 1.03, 1.09) for a change in the T max from 27 • C to 32 • C (25th to 75th percentile) [28].…”

Variáveis meteorológicas e poluição do ar e sua associação com internações respiratórias em crianças: estudo de caso em São Paulo, Brasil

“…Além disso, o efeito do frio e do calor se manifestam em tempos diferentes no organismo, as temperaturas mais baixas tendem a ter um efeito mais prolongado e as temperaturas altas apresentam um efeito curto e imediato 7,19 .…”

“…Percebe-se que os resultados deste estudo divergem das diversas contribuições científicas 6,7,8,11,19,35 que apontam que os efeitos da exposição ao frio, ao calor e à ocorrência de temperaturas extremas são significativos, para o aumento do risco de morte por doenças respiratórias. Cabe notar, também, essa diferença de resultados pela identificação dos padrões das curvas do risco e nos gráficos, pois as curvas da relação entre temperatura média do ar e as internações não seguem as formas de curvas do padrão U, J e V encontradas na literatura atual, especialmente nos estudos que relacionam a temperatura com a mortalidade.…”