Abstract
Asthma is the most common chronic illness of childhood and its prevalence is increasing, causing much concern for identification of risk factors such as air pollution. We previously conducted a study showing a relationship between asthma visits in all persons < 65 years of age to emergency departments (EDs) and air pollution in Seattle, Washington. In that study the most frequent zip codes of the visits were in the inner city. The Seattle-King County Department of Public Health (Seattle, WA) subsequently published a report which showed that the hospitalization rate for children in the inner city was over 600/100,000, whereas it was < 100/100,000 for children living in the suburbs. Therefore, we conducted the present study to evaluate whether asthma visits to hospital emergency departments in the inner city of Seattle were associated with outdoor air pollution levels. ED visits to six hospitals for asthma and daily air pollution data were obtained for 15 months during 1995 and 1996. The association between air pollution and childhood ED visits for asthma from the inner city area with high asthma hospitalization rates were compared with those from lower hospital utilization areas. Daily ED counts were regressed against fine particulate matter (PM), carbon monoxide (CO), sulfur dioxide, and nitrogen dioxide using a semiparametric Poisson regression model. Significant associations were found between ED visits for asthma in children and fine PM and CO. A change of 11 microg/m3 in fine PM was associated with a relative rate of 1.15 [95% confidence interval (CI), 1.08-1.23]. There was no stronger association between ED visits for asthma and air pollution in the higher hospital utilization area than in the lower utilization area. These findings were seen when estimated PM2.5 concentrations were below the newly adopted annual National Ambient Air Quality Standard of 15 microg/m3.
Full text
PDFImages in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Azizi B. H., Zulkifli H. I., Kasim S. Indoor air pollution and asthma in hospitalized children in a tropical environment. J Asthma. 1995;32(6):413–418. doi: 10.3109/02770909409077752. [DOI] [PubMed] [Google Scholar]
- Bates D. V., Baker-Anderson M., Sizto R. Asthma attack periodicity: a study of hospital emergency visits in Vancouver. Environ Res. 1990 Feb;51(1):51–70. doi: 10.1016/s0013-9351(05)80182-3. [DOI] [PubMed] [Google Scholar]
- Bates D. V. Observations on asthma. Environ Health Perspect. 1995 Sep;103 (Suppl 6):243–247. doi: 10.1289/ehp.95103s6243. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Burr M. L., Limb E. S., Andrae S., Barry D. M., Nagel F. Childhood asthma in four countries: a comparative survey. Int J Epidemiol. 1994 Apr;23(2):341–347. doi: 10.1093/ije/23.2.341. [DOI] [PubMed] [Google Scholar]
- Canny G. J., Reisman J., Healy R., Schwartz C., Petrou C., Rebuck A. S., Levison H. Acute asthma: observations regarding the management of a pediatric emergency room. Pediatrics. 1989 Apr;83(4):507–512. [PubMed] [Google Scholar]
- Castellsague J., Sunyer J., Sáez M., Antó J. M. Short-term association between air pollution and emergency room visits for asthma in Barcelona. Thorax. 1995 Oct;50(10):1051–1056. doi: 10.1136/thx.50.10.1051. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Crain E. F., Weiss K. B., Bijur P. E., Hersh M., Westbrook L., Stein R. E. An estimate of the prevalence of asthma and wheezing among inner-city children. Pediatrics. 1994 Sep;94(3):356–362. [PubMed] [Google Scholar]
- Delfino R. J., Becklake M. R., Hanley J. A. Reliability of hospital data for population-based studies of air pollution. Arch Environ Health. 1993 May-Jun;48(3):140–146. doi: 10.1080/00039896.1993.9940812. [DOI] [PubMed] [Google Scholar]
- Delfino R. J., Murphy-Moulton A. M., Burnett R. T., Brook J. R., Becklake M. R. Effects of air pollution on emergency room visits for respiratory illnesses in Montreal, Quebec. Am J Respir Crit Care Med. 1997 Feb;155(2):568–576. doi: 10.1164/ajrccm.155.2.9032196. [DOI] [PubMed] [Google Scholar]
- Etzel R. A. Indoor air pollution and childhood asthma: effective environmental interventions. Environ Health Perspect. 1995 Sep;103 (Suppl 6):55–58. doi: 10.1289/ehp.95103s655. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gergen P. J., Weiss K. B. Changing patterns of asthma hospitalization among children: 1979 to 1987. JAMA. 1990 Oct 3;264(13):1688–1692. [PubMed] [Google Scholar]
- Gordian M. E., Ozkaynak H., Xue J., Morris S. S., Spengler J. D. Particulate air pollution and respiratory disease in Anchorage, Alaska. Environ Health Perspect. 1996 Mar;104(3):290–297. doi: 10.1289/ehp.96104290. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hill R. A., Standen P. J., Tattersfield A. E. Asthma, wheezing, and school absence in primary schools. Arch Dis Child. 1989 Feb;64(2):246–251. doi: 10.1136/adc.64.2.246. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kelsall J. E., Samet J. M., Zeger S. L., Xu J. Air pollution and mortality in Philadelphia, 1974-1988. Am J Epidemiol. 1997 Nov 1;146(9):750–762. doi: 10.1093/oxfordjournals.aje.a009351. [DOI] [PubMed] [Google Scholar]
- Koenig J. Q., Larson T. V., Hanley Q. S., Rebolledo V., Dumler K., Checkoway H., Wang S. Z., Lin D., Pierson W. E. Pulmonary function changes in children associated with fine particulate matter. Environ Res. 1993 Oct;63(1):26–38. doi: 10.1006/enrs.1993.1123. [DOI] [PubMed] [Google Scholar]
- Lipsett M., Hurley S., Ostro B. Air pollution and emergency room visits for asthma in Santa Clara County, California. Environ Health Perspect. 1997 Feb;105(2):216–222. doi: 10.1289/ehp.97105216. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Moore C. M., Ahmed I., Mouallem R., May W., Ehlayel M., Sorensen R. U. Care of asthma: allergy clinic versus emergency room. Ann Allergy Asthma Immunol. 1997 Apr;78(4):373–380. doi: 10.1016/S1081-1206(10)63199-7. [DOI] [PubMed] [Google Scholar]
- Pantazopoulou A., Katsouyanni K., Kourea-Kremastinou J., Trichopoulos D. Short-term effects of air pollution on hospital emergency outpatient visits and admissions in the greater Athens, Greece area. Environ Res. 1995 Apr;69(1):31–36. doi: 10.1006/enrs.1995.1022. [DOI] [PubMed] [Google Scholar]
- Peters A., Dockery D. W., Heinrich J., Wichmann H. E. Short-term effects of particulate air pollution on respiratory morbidity in asthmatic children. Eur Respir J. 1997 Apr;10(4):872–879. [PubMed] [Google Scholar]
- Pope C. A., 3rd Respiratory hospital admissions associated with PM10 pollution in Utah, Salt Lake, and Cache Valleys. Arch Environ Health. 1991 Mar-Apr;46(2):90–97. doi: 10.1080/00039896.1991.9937434. [DOI] [PubMed] [Google Scholar]
- Romieu I., Meneses F., Ruiz S., Sienra J. J., Huerta J., White M. C., Etzel R. A. Effects of air pollution on the respiratory health of asthmatic children living in Mexico City. Am J Respir Crit Care Med. 1996 Aug;154(2 Pt 1):300–307. doi: 10.1164/ajrccm.154.2.8756798. [DOI] [PubMed] [Google Scholar]
- Rosenstreich D. L., Eggleston P., Kattan M., Baker D., Slavin R. G., Gergen P., Mitchell H., McNiff-Mortimer K., Lynn H., Ownby D. The role of cockroach allergy and exposure to cockroach allergen in causing morbidity among inner-city children with asthma. N Engl J Med. 1997 May 8;336(19):1356–1363. doi: 10.1056/NEJM199705083361904. [DOI] [PubMed] [Google Scholar]
- Schwartz J., Slater D., Larson T. V., Pierson W. E., Koenig J. Q. Particulate air pollution and hospital emergency room visits for asthma in Seattle. Am Rev Respir Dis. 1993 Apr;147(4):826–831. doi: 10.1164/ajrccm/147.4.826. [DOI] [PubMed] [Google Scholar]
- Sheppard L., Levy D., Norris G., Larson T. V., Koenig J. Q. Effects of ambient air pollution on nonelderly asthma hospital admissions in Seattle, Washington, 1987-1994. Epidemiology. 1999 Jan;10(1):23–30. [PubMed] [Google Scholar]
- Stieb D. M., Burnett R. T., Beveridge R. C., Brook J. R. Association between ozone and asthma emergency department visits in Saint John, New Brunswick, Canada. Environ Health Perspect. 1996 Dec;104(12):1354–1360. doi: 10.1289/ehp.961041354. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sunyer J., Spix C., Quénel P., Ponce-de-León A., Pönka A., Barumandzadeh T., Touloumi G., Bacharova L., Wojtyniak B., Vonk J. Urban air pollution and emergency admissions for asthma in four European cities: the APHEA Project. Thorax. 1997 Sep;52(9):760–765. doi: 10.1136/thx.52.9.760. [DOI] [PMC free article] [PubMed] [Google Scholar]