Abstract
Pneumonia, one of the important causes of death in children, may be induced or aggravated by particulate matter (PM). Limited research has examined the association between PM and its constituents and pediatric pneumonia-related emergency department (ED) visits. Measurements of PM2.5, PM10, and four PM2.5 constituents, including elemental carbon (EC), organic carbon (OC), nitrate, and sulfate, were extracted from 2007 to 2010 from one core station and two satellite stations in Kaohsiung City, Taiwan. Furthermore, the medical records of patients under 17 years old who had visited the ED in a medical center and had a diagnosis of pneumonia were collected. We used a time-stratified, case-crossover study design to estimate the effect of PM. The single-pollutant model demonstrated interquartile range increase in PM2.5, PM10, nitrate, OC, and EC on lag 3, which increased the risk of pediatric pneumonia by 18.2% (95% confidence interval (Cl), 8.8–28.4%), 13.1% (95% CI, 5.1–21.7%), 29.7% (95% CI, 16.4–44.5%), 16.8% (95% CI, 4.6–30.4%), and 14.4% (95% Cl, 6.5–22.9%), respectively. After PM2.5, PM10, and OC were adjusted for, nitrate and EC remained significant in two-pollutant models. Subgroup analyses revealed that nitrate had a greater effect on children during the warm season (April to September, interaction p = 0.035). In conclusion, pediatric pneumonia ED visit was related to PM2.5 and its constituents. Moreover, PM2.5 constituents, nitrate and EC, were more closely associated with ED visits for pediatric pneumonia, and children seemed to be more susceptible to nitrate during the warm season.
Highlights
Pneumonia is one of the main infectious diseases that are responsible for childhood morbidity and death, leading to about 1.3 million mortalities among children less than 5 years old in 2010 and 2011 [1]
867 (49.9%) patients presented during the warm season (April to September), and 801 (46.1%) patients presented on warm days (≥26.5 ◦ C)
Lv et al and Xiao et al demonstrated that elevated PM2.5 was related to pediatric hospital admission for pneumonia and emergency department (ED) visits for pediatric pneumonia [14,15], but some studies did not conclude on a positive correlation between ED visits for pediatric pneumonia and
Summary
Pneumonia is one of the main infectious diseases that are responsible for childhood morbidity and death, leading to about 1.3 million mortalities among children less than 5 years old in 2010 and 2011 [1]. Pneumonia is an inflammatory condition of the lung, and previous studies have shown a relationship between air pollution and lung inflammation [2,3]. A review article concluded that PM2.5 was positively related to child admission due to pneumonia [6]. The health impact of PM2.5 seemed to present regional heterogeneity. Bell et al gathered data from 202 counties in the United States and discovered the strongest relationship between PM2.5 and respiratory hospitalizations in the northeast region [7].
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