Abstract
BackgroundMany studies have evaluated associations between asthma emergency department (ED) visits, hospital admissions (HAs), and ambient ozone (O3) across the US, but not in Texas. We investigated the relationship between O3 and asthma HAs, and the potential impacts of outdoor pollen, respiratory infection HAs, and the start of the school year in Texas.MethodsWe obtained daily time-series data on asthma HAs and ambient O3 concentrations for Dallas, Houston, and Austin, Texas for the years 2003–2011. Relative risks (RRs) and 95% confidence intervals (CIs) of asthma HAs per 10-ppb increase in 8-h maximum O3 concentrations were estimated from Poisson generalized additive models and adjusted for temporal trends, meteorological factors, pollen, respiratory infection HAs, day of the week, and public holidays. We conducted a number of sensitivity analyses to assess model specification.ResultsWe observed weak associations between total asthma HAs and O3 at lags of 1 day (RR10 ppb = 1.012, 95% CI: 1.004–1.021), 2 days (RR10 ppb = 1.011, 95% CI: 1.002–1.019), and 0–3 days (RR10 ppb = 1.017, 95% CI: 1.005–1.030). The associations were primarily observed in children aged 5–14 years (e.g., for O3 at lag 0–3 days, RR10 ppb = 1.037, 95% CI: 1.011–1.064), and null in individuals 15 years or older. The effect estimates did not change significantly with adjustment for pollen and respiratory infections, but they attenuated considerably and lost statistical significance when August and September data were excluded. A significant interaction between time around the start of the school year and O3 at lag 2 day was observed, with the associations with pediatric asthma HAs stronger in August and September (RR10 ppb = 1.040, 95% CI: 1.012–1.069) than in the rest of the year (October–July) (RR10 ppb = 1.006, 95% CI: 0.986–1.026).ConclusionsWe observed small but statistically significant positive associations between total and pediatric asthma HAs and short-term O3 exposure in Texas, especially in August and September. Further research is needed to determine how the start of school could modify the observed association between O3 and pediatric asthma HAs.
Highlights
Many studies have evaluated associations between asthma emergency department (ED) visits, hospital admissions (HAs), and ambient ozone (O3) across the United States (US), but not in Texas
Descriptive statistics and pairwise correlations for asthma HAs, ambient O3, pollen, and meteorological factors are presented in Tables 1 and 2
We further evaluated whether the time period around the start of school year confounded and/or modified the associations between pediatric asthma HAs and ambient O3 concentrations (Table 5)
Summary
Numerous time-series and case-crossover epidemiology studies have been conducted to evaluate whether incidence rates of asthma ED visits and HAs increase following short-term increases in regional ozone (O3) concentrations. These studies have been conducted in a variety of locations across North America, and include analyses of ED visits for asthma in New York City [3], Atlanta [4], Seattle [5], and Canada [6, 7], and analyses of asthma HAs in New York City [8] and Seattle [9]. Most of these studies reported small, statistically significant elevations of population-average ED visits and HAs for asthma in the days following elevated O3 levels, and some evidence indicates that certain groups are more
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