Respiratory Visits Research Articles

Residential Proximity to Biorefinery Sources of Air Pollution and Respiratory Diseases in New York State.

Understanding potential health risks associated with biofuel production is critical to sustainably combating energy insecurity and climate change. However, the specific health impacts associated with biorefinery-related emissions are not yet well characterized. We evaluated the relationship between respiratory emergency department (ED) visits (2011-2015) and residential exposure to biorefineries by comparing 15 biorefinery sites to 15 control areas across New York (NY) State. We further examined these associations by biorefinery types (e.g., corn, wood, or soybean), seasons, and lower respiratory disease subtypes. We measured biorefinery exposure using residential proximity in a cross-sectional study and estimation of biorefinery emission via AERMOD-simulated modeling. After controlling for multiple confounders, we consistently found that respiratory ED visit rates among residents living within 10 km of biorefineries were significantly higher (rate ratios (RRs) range from 1.03 to 3.64) than those in control areas across our two types of exposure indices. This relationship held across biorefinery types (higher in corn and soybean biorefineries), seasons (higher in spring and winter), air pollutant types (highest for NO2), and respiratory subtypes (highest for emphysema). Further research is needed to confirm our findings.

Air Pollution, Health, and Avoidance Behavior: Evidence from South Korea

Using detailed data on the beneficiaries of the Korean National Health Insurance Service (c.2006-2015), this paper estimates the health effects of air pollution in South Korea while controlling for avoidance behaviors. In particular, I investigate changes in the respiratory hospitalization rates due to increases in PM10 and O3 concentrations. To address the endogeneity of air pollution, this paper applies the historical average concentration of air pollution that includes rich information about the meteorological and geographical factors that affect regional air pollution levels as an instrumental variable and compares the results with other count data models. I find that a 10mg/m3 increase in PM10 and a 10ppb increase in O3 lead to an increase in daily respiratory hospital visits of up to 10.39% (95% confidence intervals (CI): 4.04--16.80) and 10.93% (95% CI: 9.23-12.63), which results in additional health care costs of $67 million USD and $70 million USD, respectively. This paper also shows that the effects of PM10 and O3 are greater in more populated cities, on children's health, and for non-chronic respiratory patients.

Air Pollution, Health, and Avoidance Behavior: Evidence from South Korea

Using detailed data on the beneficiaries of the Korean National Health Insurance Service (c.2006–2015), this paper estimates the health effects of air pollution in South Korea while controlling for avoidance behaviors. In particular, we investigate changes in respiratory hospitalization rates due to increases in PM $$_{10}$$ and O $$_{3}$$ concentrations. To address the endogeneity of air pollution, this paper applies the historical average concentration of air pollution, which includes rich information about the meteorological and geographical factors that affect regional air pollution levels, as an instrumental variable and compares the results with other count data models. We find that a 10 $$\upmu$$ g/m $$^{3}$$ increase in PM $$_{10}$$ and a 10 ppb increase in O $$_{3}$$ lead to an increase in daily respiratory hospital visits of up to 10.39% [95% confidence interval (CI) 4.04–16.80] and 10.93% (95% CI 9.23–12.63), resulting in additional health care costs of US$67 million and US$70 million, respectively. This paper also shows that the effects of PM $$_{10}$$ and O $$_{3}$$ are elevated in highly populated cities, children, and patients without chronic respiratory diseases.

Particulate matter pollution and emergency room visits for respiratory diseases in a valley Basin city of Northwest China.

Epidemiological studies have suggested that particulate matter (PM) pollution seriously affects human health, particularly it is closely associated with respiratory diseases. The aim of this study is to quantitatively evaluate the effect of PMs (PM10 and PM2.5) on emergency room (ER) visits for respiratory diseases in Lanzhou, a valley basin city in northwest China. Based on the data of the ER visits, daily concentration of particulate matters and daily meteorological elements from January 1, 2013, to July 31, 2017, we used a generalized additive model (GAM) of time series to evaluate the exposure-response relationship between PMs and respiratory ER visits. Seasonal modified effects of PM2.5 and PM10 on different age and gender groups were also performed. Results showed that the highest incidence of respiratory diseases occurred in winter. Respiratory ER visits for the total were significantly associated with PM2.5 (at lag 0day) and PM10 (at lag 3days), with relative risks (RRs) of 1.042 (95%CI: 1.036 -1.047) and 1.013 (95%CI: 1.011-1.016), respectively. Effects of PM pollutants on respiratory diseases are different among different age and gender groups. Children under 15years and the elders over 60years were the most sensitive to PM pollution, and males were more sensitive than females. The results obtained in the current study would provide a scientific evidence for local government to make policy decision for prevention of respiratory diseases.

Association between ambient temperature and childhood respiratory hospital visits in Beijing, China: a time-series study (2013-2017).

Little is known on the potential impact of temperature on respiratory morbidity, especially for children whose respiratory system can be more vulnerable to climate changes. In this time-series study, Poisson generalized additive models combined with distributed lag nonlinear models were used to assess the associations between ambient temperature and childhood respiratory morbidity. The impacts of extreme cold and hot temperatures were calculated as cumulative relative risks (cum.RRs) at the 1st and 99th temperature percentiles relative to the minimum morbidity temperature percentile. Attributable fractions of respiratory morbidity due to cold or heat were calculated for temperatures below or above the minimum morbidity temperature. Effect modifications by air pollution, age, and sex were assessed in stratified analyses. A total of 877,793 respiratory hospital visits of children under 14 years old between 2013 and 2017 were collected from Beijing Children's Hospital. Overall, we observed J-shaped associations with greater respiratory morbidity risks for exposure to lower temperatures, and higher fraction of all-cause respiratory hospital visits was caused by cold (33.1%) than by heat (0.9%). Relative to the minimum morbidity temperature (25 °C, except for rhinitis, which is 31 °C), the cum.RRs for extreme cold temperature (-6 °C) were 2.64 (95%CI: 1.51-4.61) for all-cause respiratory hospital visits, 2.73 (95%CI: 1.44-5.18) for upper respiratory infection, 2.76 (95%CI: 1.56-4.89) for bronchitis, 2.12 (95%CI: 1.30-3.47) for pneumonia, 2.06 (95%CI: 1.27-3.34) for rhinitis, and 4.02 (95%CI: 2.14-7.55) for asthma, whereas the associations between extreme hot temperature (29 °C) and respiratory hospital visits were not significant. The impacts of extreme cold temperature on asthma hospital visits were greater at higher levels of ozone (O3) exposure (> 50th percentile). Our findings suggest significantly increased childhood respiratory morbidity risks at extreme cold temperature, and the impact of extreme cold temperature on asthma hospital visits can be enhanced under higher level exposure to O3.

Delayed emergencies: The composition and magnitude of non-respiratory emergency department visits during the COVID-19 pandemic.

ImportanceCOVID‐19 has been associated with excess mortality among patients not diagnosed with COVID‐19, suggesting disruption of acute health care provision may play a role.ObjectiveTo determine the degree of declines in emergency department (ED) visits attributable to COVID‐19 and determine whether these declines were concentrated among patients with fewer comorbidities and lower severity visits.DesignWe conducted a differences‐in‐differences analysis of all commercial health insurance claims for ED visits in the first 20 weeks of 2018, 2019, and 2020. The intervention period began March 9 (week 11) of 2020, following state stay‐at‐home orders.SettingWe analyzed claims from Blue Cross Blue Shield of Louisiana (BCBSLA), located in a state with an early US COVID‐19 outbreak. Visit and patient risk was assessed through comorbidities previously described as increasing the risk of COVID‐19 decompensation, the hospital location's COVID‐19 outbreak status, and the Ambulatory Care Sensitive Condition algorithm.ParticipantsThe study population comprised all ED visits from all BCBSLA members, whether admitted or discharged. There were 332,917 ED visits over the study period. The study population spanned member demographics including sex, age, and geography. Uninsured adults were not included due to data limitations.Exposure(s)The COVID‐19 outbreak beginning March 9, 2020 in Louisiana.Main outcome(s) and measure(s)The main outcome of interest for this analysis is the difference (percent change) in all ED visits, categorized as either respiratory or non‐respiratory, from week 1–20 in 2019 and week 1–10 in 2020, compared to week 11–20 in 2020.ResultsIn this differences‐in‐differences study using data from a commercial health insurer, we found that non‐respiratory ED visits declined by 39%, whereas respiratory visits did not experience a significant decline. Visits that were potentially deferrable or from lower risk patient populations showed greater declines, but even high‐risk patients and non‐avoidable visits experienced large declines in non‐respiratory ED visits. Non‐respiratory ED visits declined by only 18% in areas experiencing COVID outbreak.Conclusions and relevanceCOVID‐19 has resulted in significant avoidance of ED care, comprising a mix of deferrable and high severity care. Hospital and public health pronouncements should emphasize appropriate care seeking.

On the Short-Term Impact of Pollution: The Effect of PM 2.5 on Emergency Room Visits

In this paper, we study the effect of fine particulate matter (PM 2.5) exposure on Emergency Room (ER) visits in Chile. Our identification strategy exploits daily PM 2.5 variation within a hospital-month-year combination. Unlike previous papers, our data allow us to study the impact of high levels of pollution while controlling for avoidance behavior. We find that a one standard deviation increase in PM 2.5 increases respiratory ER visits by 1.4 percent. This effect is positive for all age groups but is stronger for children (less than five years old) and the elderly (more than 65 years old). Moreover, we find that the effects are stronger in geographical areas in which the share of emissions from residential wood burning is more than 75 percent. Finally, our results are robust to instrumenting pollution using wind direction and speed and to controlling for other pollutants.

The effect of short-term of fine particles on daily respiratory emergency in cities contaminated with wood smoke

BACKGROUND AND OBJECTIVES: The goal of this study is to evaluate in a time-series study the short-term effects of particulate matter-2.5exposure on respiratory emergency visits in six central-southern Chilean cities highly contaminated by wood smoke.METHODS: Association was assessed using both distributed lag linear and non-linear Poisson models constrained to a 7-day lag period, adjusting for temporal trends and meteorological variables and stratifying seasonally into cold and warm periods.FINDING: The results showed that the daily average concentrations of particulate matter-2.5in the cold period were 3 to 6 times those recorded in the warm period, exceeding the daily norm of 50 µg/m3 the 93.3% of the time versus 6.7%, respectively. The average daily number of respiratory emergency visits were between 30% and 64% higher in the cold period compared to the warm one. From linear models, cumulative relative risk ratios over 0-7 day lags per 10 mg/m3 of fine particle increase were between 1.004 (95% confidence Interval: 0.998 - 1.010) and 1.061 (95% confidence Interval: 1.049 - 1.074); these annual effects are attributable to the cold period impact where the cumulative risk ratios were between 1.008 (95% confidence Interval: 1.004 - 1.012) and 1.036 (95% confidence Interval: 1.026 - 1.047), since significant effects of fine particles on the studied risk were not found for the warm period.CONCLUSION: With non-linear models we observed strong increasing associations with the level of particles for the overall period. High levels of fineparticles from firewood are associated with respiratory effects observable several days after exposure. Health effects found in this study suggest that current policies tending to mitigate woodsmoke-related emissions should continue and reinforce.

16. SCORE-UC: Antibiotic Stewardship in Urgent Care

BackgroundUrgent care (UC) is a rapidly growing site of healthcare delivery. The CDC developed Core Elements for Outpatient Antibiotic Stewardship to guide development of outpatient stewardship but little experience exists in applying Core Elements to UC settings. Our objective was to evaluate the effectiveness of a UC stewardship program in a health system.Figure MethodsWe designed a UC stewardship program for Intermountain Healthcare’s 39 UC sites based on CDC Core Elements. The pre-intervention period was Aug 2017-June 2019. The intervention period was 12 months from Jul 2019 -June 2020. The program consisted of education for patients/providers about appropriate diagnosis and prescribing for respiratory conditions; media campaigns; EHR tools; and a prescribing dashboard for clinicians. The primary outcome was the percentage of respiratory visits where an antibiotic was prescribed. Secondary outcomes included the percentage of encounters receiving antibiotics for conditions where no antibiotics are indicated (e.g. bronchitis) and the percentage of encounters receiving first-line recommended therapy for conditions in which antibiotics may be warrented (otitis media, sinusitis, and pharyngitis). We used a binomial mixed effects hierarchical model to calculate the odds of antibiotic prescribing associated with the intervention period accounting for pre-intervention trends. Models account for clustering within providers and clinics. We present the results of an interim analysis after 7 months of the intervention.ResultsThe overall number of UC encounters during the study period was 1,559,403 and 41.5% were for respiratory conditions. The percentage of patients with respiratory conditions that received an antibiotic prescription declined from 49.9% pre-intervention to 35.3% during the intervention (OR 0.73, 95% CI: 0.71, 0.76), reaching a low of 30% during February 2020 (Figure). Prescribing for conditions where antibiotics are not indicated decreased (OR 0.31, 95% CI 0.26–0.36) and first line recommended therapy increased (OR 1.28, 95% CI 1.20–1.26) during the intervention.ConclusionAfter 7 months of a planned 12 month intervention, the UC stewardship program was associated with improved antibiotic prescribing.Disclosures Rajendu Srivastava, MD, AHRQ, NIH, CDC (Grant/Research Support, I hold grants from AHRQ, NIH and CDC for a variety of clinical research and implementation studies)IPASS Patient Safety Institute (Other Financial or Material Support, I am a physician founder of this company to spread handoff best practices and reduce adverse events. My employer holds my equity in this company.)

Public Health Interventions for the COVID-19 Pandemic Reduce Respiratory Tract Infection-Related Visits at Pediatric Emergency Departments in Taiwan.

Background and objective: Public health interventions such as social distancing, wearing surgical or N95 masks, and handwashing are effective in significantly reducing the risk of infection. The purpose of this article is to analyze the effect of public health interventions on respiratory tract infection-related visits to pediatric emergency departments during the COVID-19 pandemic in Taiwan.Method: Pediatric emergency department visits between January 1 2020 and April 30 2020 were included for trend analysis and compared to the same period during the past 3 years. The datasets were retrieved from Taiwan National Infectious Disease Statistics System and Kaohsiung Chang Gung Memorial Hospital. Respiratory tract infections with other diagnoses categories, including fever, asthma, and urinary tract infections, were included for subgroup analysis.Result: A significant decrease of more than 50% in respiratory tract infection-related visits was found from February to April 2020 in the national database. With regard to diagnosis category, the proportion of respiratory tract infections in Kaohsiung Chang Gung Hospital also became significantly lower in 2020 during the months of March (43.4 vs. 37.4%, p = 0.024) and April (40.1 vs. 32.2%, p < 0.001). On the other hand, the proportion of urinary tract infections was significantly higher in 2020 during March (3.7 vs. 5.2%, p = 0.033) and April (3.9 vs. 6.5%, p < 0.001), and that of asthma was also higher in April (1.6 vs. 2.6%, p = 0.025). Furthermore, the intensive care unit admission rate was relatively higher in 2020 from February, with significant differences noted in March (1.3 vs. 2.8%, p < 0.001).Conclusion: Due to public health interventions for the COVID-19 pandemic, the transmission of not only COVID-19 but also other air droplet transmitted diseases in children may have been effectively prevented.

Trends in outpatient emergency department visits during the COVID-19 pandemic at a large, urban, academic hospital system.

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has critically affected healthcare delivery in the United States. Little is known on its impact on the utilization of emergency department (ED) services, particularly for conditions that might be medically urgent. The objective of this study was to explore trends in the number of outpatient (treat and release) ED visits during the COVID-19 pandemic.MethodsWe conducted a cross-sectional, retrospective study of outpatient emergency department visits from January 1, 2019 to August 31, 2020 using data from a large, urban, academic hospital system in Utah. Using weekly counts and trend analyses, we explored changes in overall ED visits, by patients' area of residence, by medical urgency, and by specific medical conditions.ResultsWhile outpatient ED visits were higher (+6.0%) in the first trimester of 2020 relative to the same period in 2019, the overall volume between January and August of 2020 was lower (−8.1%) than in 2019. The largest decrease occurred in April 2020 (−30.4%), followed by the May to August period (−12.8%). The largest declines were observed for visits by out-of-state residents, visits classified as non-emergent, primary care treatable or preventable, and for patients diagnosed with hypertension, diabetes, headaches and migraines, mood and personality disorders, fluid and electrolyte disorders, and abdominal pain. Outpatient ED visits for emergent conditions, such as palpitations and tachycardia, open wounds, syncope and collapse remained relatively unchanged, while lower respiratory disease-related visits were 67.5% higher in 2020 relative to 2019, particularly from March to April 2020. However, almost all types of outpatient ED visits bounced back after May 2020.ConclusionsOverall outpatient ED visits declined from mid-March to August 2020, particularly for non-medically urgent conditions which can be treated in other more appropriate care settings. Our findings also have implications for insurers, policymakers, and other stakeholders seeking to assist patients in choosing more appropriate setting for their care during and after the pandemic.

Changes in air quality and its effect on emergency admissions

INTRODUCTION: Air pollution is an emerging problem in developing countries as well as the world. Effects of air pollution due to short-term exposure may lead to increase in daily mortality, respiratory and cardiovascular hospital admissions, respiratory and cardiovascular emergency room admissions, respiratory and cardiovascular primary care visits and acute respiratory symptoms. The objective of our study was to examine the relationship between air pollution and diagnoses of patients in family medicine outpatient clinic located in emergency room. MATERIAL AND METHODS: Our study enrolled 17869 patients who were admitted to the family practice outpatient clinic implemented in emergency department. The relationship between patients’ diagnosis and air quality was examined. RESULTS: The genders of the patients were 50.8% female (n = 9077) and 49.2% male (n = 8792). The mean age was 43.9 ± 19.9. Respiratory system diagnosis showed a statistically significant relationship with the air quality measurement of PM10 (p < 0.05). Patients diagnosed with upper respiratory tract disease and fatigue and hypertension on sensitive air days were found to be significantly higher than those with good air quality. There was a statistical significance between air temperature, and fatigue and cough complaints (p < 0.05). CONCLUSIONS: For human health protection, continuity of life, and environmental sustainability, air pollution should be reduced and brought under control. In our study, with the increase of particulate matter, we observed that patients with respiratory system diseases, fatigue complaints, and hypertension increased. Sharing these results with province-wide authorities may help the settlement and industrial planning in the upcoming years.

Health risks associated with PM2.5 concentration in Abidjan hospital, Côte d’Ivoire

Background/Aim Air pollution has detrimental consequences on the health of populations.. This study was to implement a Health Impact Assessment (HIA) in order to quantify the impacts of air pollution levels on the major health outcomes done in five hospitals in Abidjan with regard to air pollution concentration levels, which will provide new results. Methodology Both exposure concentrations (µg/m3) and health issues were measured. The relationship between the health outcomes and air pollution concentration were estimated using a Poisson Regression model. Results PM2.5 Concentrations from the waste burning and traffic sites were comparable with annual averages (28.51 µg/m3 and 29.69 µg/m3 ). For domestic fires, the annual average was drastically higher at 155.1 µg/m3. For persons living in Cocody, up to 22 emergency room visits could have been avoided for the rainy seasons alone, including 10 deaths. Further, 11 outpatient health center visits could have also been avoided during the rainy seasons. In Yopougon, respiratory visits to the outpatient health center could be reduced more significantly. In considering results for the entire year (26.5 avoided outcomes) and the rainy season (76.7 avoided outcomes), we obtain different results as the HIA for the rainy season was calculated using a different timeframe at a higher risk level. A further 30 outpatient visits for heart and skin problems could also be avoided during the rainy season, given an adherence to WHO recommended levels. Conclusion Using the number of visits to either an outpatient health center or an emergency room as a proxy for adverse health effects, an association was seen between PM2.5 concentration levels and respiratory, cardiological, dermatological symptoms as well as mortality in the metropolitan area of Abidjan. Overall, we estimate that 143 hospital visits could have been avoided during the rainy seasons of our study period.

Association between PM10 from vegetation fire events and hospital visits by children in upper northern Thailand

Few studies have focused on the effects of exposure to air pollutants from vegetation fire events (including forest fire and the burning of crop residues) among children. In this study we aimed to investigate the association between PM10 concentrations and hospital visits by children to address respiratory disease, conjunctivitis, and dermatitis. We examined and compared these associations by the presence of vegetation fire events on a given day (burning, non-burning, and mixed) across the upper northern region of Thailand from 2014 through 2018. A vegetation burning was defined when a fire hotspot (obtained from NASA-MODIS) exceeded the 90th percentile of the entire region and PM10 concentration was over 100 μg/m3. To determine the association between hospital visits among children with PM10 concentrations on burning and non-burning days, we performed a time-stratified case-crossover analysis fitted with conditional logistic regression for each province. A random-effects meta-analysis was applied to pool province-specific effect estimates. The number of burning days ranged from 64 to 139 days across eight provinces. A 10 μg/m3 increase in PM10 concentration on a burning day was associated with a respiratory disease-related hospital visit at lag 0 (OR = 1.01 (95% CIs: 1.00, 1.02)). This association was not observed for hospital visits related to conjunctivitis and dermatitis. A positive association was also observed between PM10 concentration on non-burning days and hospital visits related to respiratory disease at lag 0 (OR = 1.03 (95% CIs: 1.02, 1.04)). Hospital visits for conjunctivitis and dermatitis were significantly associated with PM10 concentration at lag 0 on both non-burning and mixed days.

Effectiveness of expiratory flow acceleration in patients with Parkinson's disease and swallowing deficiency: A preliminary study

ObjectivesParkinson's disease (PD) causes dysfunction both to swallowing and to the cough mechanism. Oropharyngeal dysphagia is the main cause of pneumonia, due to silent aspiration of food and saliva. Pneumonia is the leading cause of death in PD. Different strategies exist to reduce the risk of inhalation and associated lung infections, but evidence of their efficacy is still unclear. The aim of this preliminary study was to investigate if adding an expiratory flow acceleration (EFA®) technique to standard therapy (ST) for dysphagia can reduce the incidence of bronchopulmonary infections and improve quality of life, respiratory function parameters, cough, and airways encumbrance perception. Materials and MethodsTwenty-five patients with PD were randomized to two groups: ST vs. ST + EFA. Patients were re-assessed at 30, 180 and 360 days from start of treatment. The primary outcome was the incidence of respiratory exacerbations together with quality of life score (PDQ-39). Secondary outcomes were changes in respiratory function tests, cough capacity (CPEF), perceived health status (Euro-QOL-VAS), cough, and upper airways encumbrance perception evaluated by visual numeric scale (VNS). ResultsTwenty patients concluded the study (10 each group). Albeit the difference was not significant, less respiratory infections, symptoms, hospital admissions and medical visits were found in the study group. Furthermore, there was a significant difference in cough effectiveness measured with the peak cough expiratory flow (PCEF) and other spirometry parameters (FEV1, FVC), and also in specific and generic health-related quality of life measures (PDQ-39, Euro-QoL-VAS). ConclusionThe results of this preliminary study support the use of EFA® technology in Parkinson's patients with dysphagia to reduce the risk of respiratory complications. Nevertheless, further studies are needed in a larger, more representative sample to definitively confirm the usefulness of this technique in PD patients.

Innate IFN-lambda responses to dsRNA in the human infant airway epithelium and clinical regulatory factors during viral respiratory infections in early life.

IFN lambda (type III-IFN-λ1) is a molecule primarily produced by epithelial cells that provides an important first-line defence against viral respiratory infections and has been linked to the pathogenesis of viral-induced wheezing in early life. The goal of this study was to better understand the regulation of innate IFN-lambda responses in vitro in primary human infant airway epithelial cells (AECs) and in vivo using nasal aspirates during viral respiratory infections. IFN-lambda protein levels were quantified: (a) in human infant AECs exposed to (poly(I:C) dsRNA) under different experimental conditions (n=8 donors); and (b) in nasal aspirates of young children (≤3years) hospitalized with viral respiratory infection (n=138) and in uninfected controls (n=74). In vivo IFN-lambda airway levels during viral infections were correlated with individual characteristics and respiratory disease parameters. Our in vitro experiments showed that the poly(I:C)-induced innate production of IFN lambda in human infant AECs is regulated by (a) p38-MAPK/NF-kB dependent mechanism; and (b) exposure to pro-inflammatory signals such as IL1β. Our in vivo studies demonstrated that (a) infants (<18months) had higher virus-induced IFN-lambda airway secretion; (b) subjects with RSV infection showed the highest IFN-lambda airway levels; and (c) individuals with the highest virus-induced IFN-lambda levels (>90th percentile) had higher viral loads and were more likely to have respiratory sick visits within 12months of discharge (OR=5.8). IFN-lambda responses to dsRNA in the human infant airway epithelium are regulated by p38-MAPK and NF-kB signalling. High in vivo IFN-lambda production is influenced by virus type and associated with recurrent respiratory sick visits in young children.

Respiratory illness, hospital visits, and health costs: Is it air pollution or pollen?

BackgroundBoth air pollution and airborne pollen can cause respiratory health problems. Since both are often jointly present in ambient air, it is important to control for one while estimating the effect of the other when considering pollution-abating policies. To date only a limited number of studies have considered the health effects of both irritants jointly for a general population, and for a sufficiently long time period to allow for variation in seasonal concentrations of both components. The primary goal of this study is to determine the causal impact of fine particulate matter (PM2.5) on hospital visits and related treatment costs, while controlling for potentially confounding pollen effects. Our study area is the metropolitan hub of Reno/Sparks in Northern Nevada. MethodsTaking advantage of a rare sample of daily pollen counts over a prolonged period of time (2009–2015), we model the effects of PM2.5 and pollen on respiratory-related hospital admissions for the population at large, plus specific age groups. Pollen data are provided by a local allergy clinic. Data on PM2.5 and other air pollutants are obtained from the U.S. Environmental Protection Agency's air quality data web site. We collect daily meteorological data from the National Centers for Environmental Information's data repository. Data on hospital admissions are given by the Nevada Center for Surveys, Evaluations, and Statistics. Our econometric approach centers on a fully robust count data (Poisson) model, estimated via Quasi-Maximum Likelihood. ResultsWe find that for our sample PM2.5 effects are largely robust to the inclusion of both pollen counts and temporal indicators. In contrast, pollen effects vanish when time fixed effects are added, pointing at their correlation with unobserved temporal confounders. At the same time, model fit improves with the inclusion of temporal indicators. Based on our preferred specification, we find a significant PM2.5 effect of approximately 0.5% additional hospital visits per day due to a one μg/m3 increase in PM2.5. This translates into expected augmented treatment costs of $2700 per day for the same unit-change in PM2.5. These figures can mount quickly when more pronounced and/or longer episodes of particulate matter pollution are considered, perhaps due to wildfire smoke. For instance, the expected increase in patients and costs due to a month-long 10-unit-jump of PM2.5 over the long-run annual average would amount to an extra 70 patients and approximately $680,000 in additional treatment costs.

Respiratory Virus-related Emergency Department Visits and Hospitalizations Among Infants in New Zealand.

Estimates of the contribution of respiratory viruses to emergency department (ED) utilization remain limited. We conducted surveillance of infants with acute respiratory infection (ARI) associated ED visits, which then resulted in either hospital admission or discharge home. Seasonal rates of specific viruses stratified by age, ethnicity, and socioeconomic status were estimated for both visits discharged directly from ED and hospitalizations using rates of positivity for each virus. During the 2014-2016 winter seasons, 3585 (66%) of the 5412 ARI ED visits were discharged home directly and 1827 (34%) were admitted to hospital. Among visits tested for all respiratory viruses, 601/1111 (54.1%) of ED-only and 639/870 (73.4%) of the hospital-admission groups were positive for at least one respiratory virus. Overall, respiratory virus-associated ED visit rates were almost twice as high as hospitalizations. Respiratory syncytial virus was associated with the highest ED (34.4 per 1000) and hospitalization rates (24.6 per 1000) among infants. ED visit and hospitalization rates varied significantly by age and virus. Māori and Pacific children had significantly higher ED visit and hospitalization rates for all viruses compared with children of other ethnicities. Many infants with acute respiratory virus infections are managed in the ED rather than admitted to the hospital. Higher rates of ED-only versus admitted acute respiratory virus infections occur among infants living in lower socioeconomic households, older infants and infants of Māori or Pacific versus European ethnicity. Respiratory virus infections resulting in ED visits should be included in measurements of ARI disease burden.

Short-term effects of air pollution on daily single- and co-morbidity cardiorespiratory outpatient visits

Several studies have noted that the existence of comorbidities lead to an increase in the risk of premature mortality and morbidity. Most of the studies examining the effects of air pollution on comorbidity visits were from Northern American countries, with scarce literature from Asia. This study contributes to existing, yet limited understanding of air pollution-comorbidity by examining the effects of daily air pollutants on outpatient single morbidity and comorbid cardiorespiratory visits in Japan.A total of 1,452,505 outpatient cardiorespiratory visits were recorded among the 21 Japanese cities from 2013 to 2016. Daily outpatient cardiorespiratory visit data were obtained from a health insurance claims database managed by the Japan Medical Data Center Co., Ltd. (JMDC). A time-stratified case crossover analysis coupled with Generalized Additive Mixed Model was used to analyze the association of daily air pollutants (particulate matter 2.5 μm or less in diameter, ozone and nitrogen dioxide) on daily single (respiratory and cardiovascular) and comorbidity health outcomes. We further examined single and cumulative effects for 0–3 and 0–14 lag periods.Ozone, NO2, and PM2.5 were positively associated with cardiorespiratory visits in either shorter or longer lags, with more apparent comorbidity associations with NO2 exposure. A 10-unit increase in NO2, after adjusting for ozone, was associated with a 2.24% (95% CI: 1.34–3.15) and 6.49% (95% CI: 5.00–8.01) increase in comorbidity visit at Lag 0 (of Lag 0–3) and cumulative lag 0–3, respectively. Our results contribute to existing evidence suggesting that short-term and extended exposure to air pollution elicit health risks on cardiovascular, respiratory and comorbid clinic visits. Exposure to NO2, in particular, was associated with increase in the risk of single and comorbidity cardiorespiratory visits. Results can be potentially utilized for both individual health (e.g. risk population health management) and health facility management (e.g. health visit influx determination).

Increase in Pediatric Respiratory Visits Associated with Santa Ana Wind-Driven Wildfire Smoke and PM2.5 Levels in San Diego County.

Rationale: There is significant evidence of increased healthcare utilization from cardiopulmonary causes in adults from exposure to wildfire smoke, but evidence in pediatric age groups is limited.Objectives: To quantify and examine the healthcare utilization effects of the December 2017 Lilac Fire in San Diego County among pediatric patients at the Rady Children's Hospital (RCH) emergency department and urgent care (UC) clinics.Methods: Using data from 2011 to 2017, including data on daily particulate matter <2.5 μm (PM2.5) in an inverse-distance interpolation model and RCH electronic medical records, we retrospectively analyzed pediatric respiratory visits at the RCH emergency department and UC clinics during the Santa Ana wind (SAW)-driven Lilac Fire from December 7 to 16, 2017. An interrupted time series study design was applied as our primary analysis to compare the observed pediatric respiratory visits from December 7 to 16, 2017 to what would have occurred in a counterfactual situation, namely, if the Lilac Fire had not occurred. A complementary descriptive spatial analysis was also used to evaluate the geographic distribution of respiratory visits in relationship to satellite imaging of the Lilac Fire and the associated wind pattern.Results: The Lilac Fire was associated with 16.0 (95% confidence interval [CI], 11.2-20.9) excess respiratory visits per day at the RCH emergency department across all pediatric age groups. Children aged 0 to 5 years had the highest absolute excess respiratory visits per day with 7.3 (95% CI, 3.0-11.7), whereas those aged 6 to 12 years had the highest relative increase in visits, with 3.4 (95% CI, 2.3-4.6). RCH UC clinics had similar results. The top five ZIP codes in San Diego County with the highest standard deviations of age-adjusted respiratory visits were all located generally downwind of the fire perimeter, as expected for the SAW pattern.Conclusions: We have demonstrated an increase in pediatric respiratory visits during the SAW-driven Lilac Fire in San Diego County in a patterned geographic distribution that is attributable to an increase in PM2.5 exposure. Younger children were particularly affected. Climate change is expected to result in more frequent and extensive wildfires in the region and will require greater preparedness and adaptation efforts to protect vulnerable populations, such as young children.