Short-Term Associations between Air Pollution Concentrations and Respiratory Health—Comparing Primary Health Care Visits, Hospital Admissions, and Emergency Department Visits in a Multi-Municipality Study

Abstract

Acute effects of air pollution on respiratory health have traditionally been investigated with data on inpatient admissions, emergency room visits, and mortality. In this study, we aim to describe the total acute effects of air pollution on health care use for respiratory symptoms (ICD10-J00-J99). This will be done by investigating primary health care (PHC) visits, inpatient admissions, and emergency room visits together in five municipalities in southern Sweden, using a case-crossover design. Between 2005 and 2010, there were 81,019 visits to primary health care, 38,217 emergency room visits, and 25,271 inpatient admissions for respiratory symptoms in the study area. There was a 1.85% increase (95% CI: 0.52 to 3.20) in the number of primary health care visits associated with a 10 µg/m3 increase in nitrogen dioxide (NO2) levels in Malmö, but not in the other municipalities. Air pollution levels were generally not associated with emergency room visits or inpatient admissions, with one exception (in Helsingborg there was a 2.52% increase in emergency room visits for respiratory symptoms associated with a 10 µg/m3 increase in PM10). In conclusion, the results give weak support for short-term effects of air pollution on health care use associated with respiratory health symptoms in the study area.

Impact of air pollution on hospital admissions with a focus on respiratory diseases: a time-series multi-city analysis

“…On such normalized data set, the hypothesized association between air pollution and number of hospitalizations was analyzed using at first a simple correlation analysis. As the association between air pollution and respiratory illness may be delayed in time (Zhang et al 2018 ; Sinclair and Tolsma 2004 ), a potential lag effect from 0 to 10 days has been taken into consideration (Taj et al 2017 ; Lall et al 2011 ). To further explore the lag effect, on the data that showed bigger potential association, the correlation analyses was combined with a distributed lag nonlinear model (DLNM) (Gasparrini et al 2010 , 2012 ).…”

The short-term effects of air pollution on respiratory disease hospitalizations in 5 cities in Poland: comparison of time-series and case-crossover analyses

“…By matching the day of the week and season, case-crossover study allows control for these confounding by design. The year, month, and holidays as nonoverlapping strata have been used to help avoid the bias due to overlap (Taj et al 2017), matching the days of the week as control days.…”

“…Often the choice falls on regression models. Both time-series (Bell et al 2004;Zheng et al 2015;Jie et al 2018) and case-crossover designs are widely used (Taj et al 2017;Leiser et al 2018). Although, in addition to these consolidated study designs, for the same purposes, also other methods are being routinely used, e.g., crosssectional studies or case-control studies (Nieuwenhuijsen 2015).…”

Outdoor Air Pollution and Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis

“…In 2012, AAP caused 3 million premature death worldwide, with 88% of these premature deaths in low and middle-income (LMI) countries (22). AAP was associated with many adverse health conditions including cardiopulmonary disease, lung cancer and acute lower respiratory infection (23,24). In addition, air pollution was significantly associated with insulin resistance and diabetes-related mortality (25)(26)(27).…”