Primary and pharmaceutical care usage concurrent associations with a severe smoke episode and low ambient air pollution in early life

Myriam Ziou; Caroline X Gao; Amanda J Wheeler; Graeme R Zosky; Nicola Stephens; Luke D Knibbs; Grant J Williamson; Shannon M Melody; Alison J Venn; Marita F Dalton; Shyamali C Dharmage; Fay H Johnston

doi:10.1016/j.scitotenv.2023.163580

Primary and pharmaceutical care usage concurrent associations with a severe smoke episode and low ambient air pollution in early life

Sci Total Environ. 2023 Jul 20:883:163580. doi: 10.1016/j.scitotenv.2023.163580. Epub 2023 Apr 24.

Authors

Affiliations

¹ Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania 7000, Australia.
² School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria 3052, Australia.
³ Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania 7000, Australia; Commonwealth Scientific and Industrial Research Organisation (CSIRO) Oceans and Atmosphere, Aspendale, Victoria 3195, Australia.
⁴ Tasmanian School of Medicine, University of Tasmania, Hobart, Tasmania 7000, Australia; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania 7000, Australia.
⁵ Tasmanian School of Medicine, University of Tasmania, Hobart, Tasmania 7000, Australia.
⁶ School of Public Health, The University of Sydney, NSW 2006, Australia; Public Health Research Analytics and Methods for Evidence, Public Health Unit, Sydney Local Health District, Camperdown, NSW 2050, Australia.
⁷ School of Natural Sciences, University of Tasmania, Sandy Bay, Tasmania 7005, Australia.
⁸ Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Carlton, Victoria 3052, Australia.
⁹ Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania 7000, Australia. Electronic address: Fay.Johnston@utas.edu.au.

PMID: 37100138
DOI: 10.1016/j.scitotenv.2023.163580

Abstract

Background: Due to climate change, landscape fires account for an increasing proportion of air pollution emissions, and their impacts on primary and pharmaceutical care are little understood.

Objectives: To evaluate associations between exposure in two early life periods to severe levels of PM_2.5 from a mine fire, background PM_2.5, and primary and pharmaceutical care.

Methods: We linked records of births, general practitioner (GP) presentations and prescription dispensing for children born in the Latrobe Valley, Australia, 2012-2014, where a severe mine fire occurred in February-March 2014 in an area with otherwise low levels of ambient PM_2.5. We assigned modelled exposure estimates for fire-related (cumulative over the fire and peak 24-hour average) and annual ambient PM_2.5 to residential address. Associations with GP presentations and dispensing of prescribed medications in the first two years of life (exposure in utero) and in the two years post-fire (exposure in infancy) were estimated using two-pollutant quasi-Poisson regression models.

Results: Exposure in utero to fire-related PM_2.5 was associated with an increase in systemic steroid dispensing (Cumulative: IRR = 1.11, 95%CI = 1.00-1.24 per 240 μg/m³; Peak: IRR = 1.15, 95%CI = 1.00-1.32 per 45 μg/m³), while exposure in infancy was associated with antibiotic dispensing (Cumulative: IRR = 1.05, 95%CI = 1.00-1.09; Peak: IRR = 1.06, 95%CI = 1.00-1.12). Exposure in infancy to ambient PM_2.5, despite relatively low levels from a global perspective (Median = 6.1 μg/m³), was associated with an increase in antibiotics (IRR = 1.10, 95%CI = 1.01-1.19 per 1.4 μg/m³) and in GP presentations (IRR = 1.05, 95%CI = 1.00-1.11), independently from exposure to the fire. We also observed differences in associations between sexes with GP presentations (stronger in girls) and steroid skin cream dispensing (stronger in boys).

Discussion: Severe medium-term concentrations of PM_2.5 were linked with increased pharmaceutical treatment for infections, while chronic low levels were associated with increased prescriptions dispensed for infections and primary care usage. Our findings also indicated differences between sexes.

Keywords: Air pollution; Atopic dermatitis; Child health; Climate change; Infections; Pharmaceuticals.

MeSH terms

Air Pollutants* / analysis
Air Pollution* / analysis
Child
Environmental Exposure / analysis
Female
Fires*
Humans
Male
Particulate Matter / analysis
Pharmaceutical Services*
Smoke / analysis

Substances

Smoke
Air Pollutants
Particulate Matter