Abstract
Study objective: Assess associations between short-term exposure to gaseous pollutants and asthma hospitalisation among boys and girls 6 to12 years of age.
Design: A bi-directional case-crossover analysis was used. Conditional logistic regression models were fitted to the data for boys and girls separately. Exposures averaged over periods ranging from one to seven days were used to assess the effects of gaseous pollutants on asthma hospitalisation. Estimated relative risks for asthma hospitalisation were calculated for an incremental exposure corresponding to the interquartile range in pollutant levels, adjusted for daily weather conditions and concomitant exposure to particulate matter.
Setting: Toronto, Ontario, Canada.
Participants: A total of 7319 asthma hospitalisations for children 6 to 12 years of age (4629 for boys and 2690 for girls) in Toronto between 1981 and 1993.
Main results: A significant acute effect of carbon monoxide on asthma hospitalisation was found in boys, and sulphur dioxide showed significant effects of prolonged exposure in girls. Nitrogen dioxide was positively associated with asthma admissions in both sexes. The lag time for certain gaseous pollutant effects seemed to be shorter in boys (around two to three days for carbon monoxide and nitrogen dioxide), as compared with girls (about six to seven days for sulphur dioxide and nitrogen dioxide). The effects of gaseous pollutants on asthma hospitalisation remained after adjustment of particulate matter. The data showed no association between ozone and asthma hospitalisation in children.
Conclusions: The study showed positive relations between gaseous pollutants (carbon monoxide, sulphur dioxide, and nitrogen dioxide) at comparatively low levels and asthma hospitalisation in children, using bi-directional case-crossover analyses. Though, the effects of certain specific gaseous pollutants were found to vary in boys and girls.
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Selected References
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- Anderson H. R., Limb E. S., Bland J. M., Ponce de Leon A., Strachan D. P., Bower J. S. Health effects of an air pollution episode in London, December 1991. Thorax. 1995 Nov;50(11):1188–1193. doi: 10.1136/thx.50.11.1188. [DOI] [PMC free article] [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]
- Bateson T. F., Schwartz J. Control for seasonal variation and time trend in case-crossover studies of acute effects of environmental exposures. Epidemiology. 1999 Sep;10(5):539–544. [PubMed] [Google Scholar]
- Bateson T. F., Schwartz J. Selection bias and confounding in case-crossover analyses of environmental time-series data. Epidemiology. 2001 Nov;12(6):654–661. doi: 10.1097/00001648-200111000-00013. [DOI] [PubMed] [Google Scholar]
- Bjornson C. L., Mitchell I. Gender differences in asthma in childhood and adolescence. J Gend Specif Med. 2000 Nov-Dec;3(8):57–61. [PubMed] [Google Scholar]
- Burnett R. T., Cakmak S., Raizenne M. E., Stieb D., Vincent R., Krewski D., Brook J. R., Philips O., Ozkaynak H. The association between ambient carbon monoxide levels and daily mortality in Toronto, Canada. J Air Waste Manag Assoc. 1998 Aug;48(8):689–700. doi: 10.1080/10473289.1998.10463718. [DOI] [PubMed] [Google Scholar]
- Burnett R. T., Dales R. E., Brook J. R., Raizenne M. E., Krewski D. Association between ambient carbon monoxide levels and hospitalizations for congestive heart failure in the elderly in 10 Canadian cities. Epidemiology. 1997 Mar;8(2):162–167. doi: 10.1097/00001648-199703000-00007. [DOI] [PubMed] [Google Scholar]
- Burnett R. T., Smith-Doiron M., Stieb D., Cakmak S., Brook J. R. Effects of particulate and gaseous air pollution on cardiorespiratory hospitalizations. Arch Environ Health. 1999 Mar-Apr;54(2):130–139. doi: 10.1080/00039899909602248. [DOI] [PubMed] [Google Scholar]
- Cakmak S., Burnett R., Krewski D. Adjusting for temporal variation in the analysis of parallel time series of health and environmental variables. J Expo Anal Environ Epidemiol. 1998 Apr-Jun;8(2):129–144. [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]
- Clark N. M., Brown R. W., Parker E., Robins T. G., Remick D. G., Jr, Philbert M. A., Keeler G. J., Israel B. A. Childhood asthma. Environ Health Perspect. 1999 Jun;107 (Suppl 3):421–429. doi: 10.1289/ehp.99107s3421. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dab W., Medina S., Quénel P., Le Moullec Y., Le Tertre A., Thelot B., Monteil C., Lameloise P., Pirard P., Momas I. Short term respiratory health effects of ambient air pollution: results of the APHEA project in Paris. J Epidemiol Community Health. 1996 Apr;50 (Suppl 1):s42–s46. doi: 10.1136/jech.50.suppl_1.s42. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Delfino R. J., Becklake M. R., Hanley J. A. The relationship of urgent hospital admissions for respiratory illnesses to photochemical air pollution levels in Montreal. Environ Res. 1994 Oct;67(1):1–19. doi: 10.1006/enrs.1994.1061. [DOI] [PubMed] [Google Scholar]
- Evans M. J., Cabral L. J., Stephens R. J., Freeman G. Renewal of alveolar epithelium in the rat following exposure to NO2. Am J Pathol. 1973 Feb;70(2):175–198. [PMC free article] [PubMed] [Google Scholar]
- Lee J. T., Schwartz J. Reanalysis of the effects of air pollution on daily mortality in Seoul, Korea: A case-crossover design. Environ Health Perspect. 1999 Aug;107(8):633–636. doi: 10.1289/ehp.99107633. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Levy D., Lumley T., Sheppard L., Kaufman J., Checkoway H. Referent selection in case-crossover analyses of acute health effects of air pollution. Epidemiology. 2001 Mar;12(2):186–192. doi: 10.1097/00001648-200103000-00010. [DOI] [PubMed] [Google Scholar]
- Lipfert F. W., Hammerstrom T. Temporal patterns in air pollution and hospital admissions. Environ Res. 1992 Dec;59(2):374–399. doi: 10.1016/s0013-9351(05)80043-x. [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]
- Maclure M. The case-crossover design: a method for studying transient effects on the risk of acute events. Am J Epidemiol. 1991 Jan 15;133(2):144–153. doi: 10.1093/oxfordjournals.aje.a115853. [DOI] [PubMed] [Google Scholar]
- Martinez F. D., Wright A. L., Taussig L. M., Holberg C. J., Halonen M., Morgan W. J. Asthma and wheezing in the first six years of life. The Group Health Medical Associates. N Engl J Med. 1995 Jan 19;332(3):133–138. doi: 10.1056/NEJM199501193320301. [DOI] [PubMed] [Google Scholar]
- Millar W. J., Hill G. B. Childhood asthma. Health Rep. 1998 Winter;10(3):9–(FRE). [PubMed] [Google Scholar]
- Moolgavkar S. H., Luebeck E. G., Hall T. A., Anderson E. L. Air pollution and daily mortality in Philadelphia. Epidemiology. 1995 Sep;6(5):476–484. doi: 10.1097/00001648-199509000-00003. [DOI] [PubMed] [Google Scholar]
- Morgan G., Corbett S., Wlodarczyk J. Air pollution and hospital admissions in Sydney, Australia, 1990 to 1994. Am J Public Health. 1998 Dec;88(12):1761–1766. doi: 10.2105/ajph.88.12.1761. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Navidi W. Bidirectional case-crossover designs for exposures with time trends. Biometrics. 1998 Jun;54(2):596–605. [PubMed] [Google Scholar]
- Neas L. M., Schwartz J., Dockery D. A case-crossover analysis of air pollution and mortality in Philadelphia. Environ Health Perspect. 1999 Aug;107(8):629–631. doi: 10.1289/ehp.99107629. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Norris G., YoungPong S. N., Koenig J. Q., Larson T. V., Sheppard L., Stout J. W. An association between fine particles and asthma emergency department visits for children in Seattle. Environ Health Perspect. 1999 Jun;107(6):489–493. doi: 10.1289/ehp.99107489. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ponce de Leon A., Anderson H. R., Bland J. M., Strachan D. P., Bower J. Effects of air pollution on daily hospital admissions for respiratory disease in London between 1987-88 and 1991-92. J Epidemiol Community Health. 1996 Apr;50 (Suppl 1):s63–s70. doi: 10.1136/jech.50.suppl_1.s63. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pönkä A. Asthma and low level air pollution in Helsinki. Arch Environ Health. 1991 Sep-Oct;46(5):262–270. doi: 10.1080/00039896.1991.9934386. [DOI] [PubMed] [Google Scholar]
- Redline S., Gold D. Challenges in interpreting gender differences in asthma. Am J Respir Crit Care Med. 1994 Nov;150(5 Pt 1):1219–1221. doi: 10.1164/ajrccm.150.5.7952543. [DOI] [PubMed] [Google Scholar]
- Schouten J. P., Vonk J. M., de Graaf A. Short term effects of air pollution on emergency hospital admissions for respiratory disease: results of the APHEA project in two major cities in The Netherlands, 1977-89. J Epidemiol Community Health. 1996 Apr;50 (Suppl 1):s22–s29. doi: 10.1136/jech.50.suppl_1.s22. [DOI] [PMC free article] [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]
- Schwartz J., Spix C., Touloumi G., Bachárová L., Barumamdzadeh T., le Tertre A., Piekarksi T., Ponce de Leon A., Pönkä A., Rossi G. Methodological issues in studies of air pollution and daily counts of deaths or hospital admissions. J Epidemiol Community Health. 1996 Apr;50 (Suppl 1):S3–11. doi: 10.1136/jech.50.suppl_1.s3. [DOI] [PMC free article] [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]
- Tattersfield A. E. Air pollution: brown skies research. Thorax. 1996 Jan;51(1):13–22. doi: 10.1136/thx.51.1.13. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Vigotti M. A., Rossi G., Bisanti L., Zanobetti A., Schwartz J. Short term effects of urban air pollution on respiratory health in Milan, Italy, 1980-89. J Epidemiol Community Health. 1996 Apr;50 (Suppl 1):s71–s75. doi: 10.1136/jech.50.suppl_1.s71. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Walters S., Griffiths R. K., Ayres J. G. Temporal association between hospital admissions for asthma in Birmingham and ambient levels of sulphur dioxide and smoke. Thorax. 1994 Feb;49(2):133–140. doi: 10.1136/thx.49.2.133. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Walters S., Phupinyokul M., Ayres J. Hospital admission rates for asthma and respiratory disease in the West Midlands: their relationship to air pollution levels. Thorax. 1995 Sep;50(9):948–954. doi: 10.1136/thx.50.9.948. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Weisel C. P., Cody R. P., Lioy P. J. Relationship between summertime ambient ozone levels and emergency department visits for asthma in central New Jersey. Environ Health Perspect. 1995 Mar;103 (Suppl 2):97–102. doi: 10.1289/ehp.95103s297. [DOI] [PMC free article] [PubMed] [Google Scholar]
- White M. C., Etzel R. A., Wilcox W. D., Lloyd C. Exacerbations of childhood asthma and ozone pollution in Atlanta. Environ Res. 1994 Apr;65(1):56–68. doi: 10.1006/enrs.1994.1021. [DOI] [PubMed] [Google Scholar]
- von Mutius E. Progression of allergy and asthma through childhood to adolescence. Thorax. 1996 Jan;51 (Suppl 1):S3–S6. doi: 10.1136/thx.51.suppl_1.s3. [DOI] [PMC free article] [PubMed] [Google Scholar]
