Ambient air pollution and emergency department visits for asthma: a multi-city assessment of effect modification by age

J Expo Sci Environ Epidemiol. 2016 Mar-Apr;26(2):180-8. doi: 10.1038/jes.2015.57. Epub 2015 Sep 9.

Abstract

Previous studies have found strong associations between asthma morbidity and major ambient air pollutants. Relatively little research has been conducted to assess whether age is a factor conferring susceptibility to air pollution-related asthma morbidity. We investigated the short-term relationships between asthma emergency department (ED) visits and ambient ozone (O3), carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), and fine particulate matter (PM2.5) in Atlanta (1993-2009), Dallas (2006-2009), and St. Louis (2001-2007). City-specific daily time-series analyses were conducted to estimate associations by age group (0-4, 5-18, 19-39, 40-64, and 65+ years). Sub-analyses were performed stratified by race and sex. City-specific rate ratios (RRs) were combined by inverse-variance weighting to provide an overall association for each strata. The overall RRs differed across age groups, with associations for all pollutants consistently strongest for children aged 5-18 years. The patterns of association across age groups remained generally consistent when models were stratified by sex and race, although the strong observed associations among 5-18 year olds appeared to be partially driven by non-white and male patients. Our findings suggest that age is a susceptibility factor for asthma exacerbations in response to air pollution, with school-age children having the highest susceptibility.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Age Distribution
  • Age Factors
  • Aged
  • Air Pollutants / adverse effects*
  • Air Pollutants / analysis
  • Air Pollution / adverse effects*
  • Air Pollution / analysis
  • Animals
  • Asthma / chemically induced*
  • Asthma / epidemiology*
  • Carbon Monoxide / adverse effects
  • Carbon Monoxide / analysis
  • Child
  • Child, Preschool
  • Cities
  • Emergency Service, Hospital
  • Environmental Monitoring
  • Female
  • Georgia / epidemiology
  • Humans
  • Infant
  • Male
  • Middle Aged
  • Missouri / epidemiology
  • Nitrogen Dioxide / adverse effects
  • Nitrogen Dioxide / analysis
  • Ozone / adverse effects
  • Particle Size
  • Particulate Matter / adverse effects*
  • Particulate Matter / analysis
  • Poisson Distribution
  • Risk Factors
  • Sulfur Dioxide / adverse effects
  • Sulfur Dioxide / analysis
  • Texas / epidemiology
  • Young Adult

Substances

  • Air Pollutants
  • Particulate Matter
  • Sulfur Dioxide
  • Ozone
  • Carbon Monoxide
  • Nitrogen Dioxide