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An approach to represent a combined exposure to air pollution

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Szyszkowicz M.

International Journal of Occupational Medicine and Environmental Health

2015

vol. 28

issue 5

823-830

Objectives The objective of this study was to present a technique for estimating the effect of ambient air pollution mix on health outcomes. Material and Methods We created a technique of indexing air pollution mix as a cause of the increased odds of health problems. As an illustrative example, we analyzed the impact of pollution on the frequency of emergency department (ED) visits due to colitis among young patients (age < 15 years, N = 11 110). Our technique involves 2 steps. First, we considered 6 ambient air pollutants (carbon monoxide, nitrogen dioxide, sulphur dioxide, ozone, and 2 measures of particulate matter) treating each pollutant as a single exposure. Odds ratios (ORs) for ED visits associated with a standard increase (interquartile range – IQR) in the pollutants levels were calculated using the case-crossover technique. The ORs and their 95% confidence intervals (95% CIs) were also found for lagged exposures (for lags 1–9 days). Second, we defined a Health Air Study Index (HASI) to represent the combined impact of the 6 air pollutants. Results We obtained positive and statistically significant results for individual air pollutants and among them the following estimations: OR = 1.06 (95% CI: 1.02–1.1, NO₂ lag 3, IQR = 12.8 ppb), OR = 1.04 (95% CI: 1.01–1.07, SO₂ lag 4, IQR = 2.3 ppb), OR = 1.04 (95% CI: 1–1.06, PM lag 3, IQR = 6.2 μg/m³). Among the re-calculated ORs with the HASI values as an exposure, the highest estimated value was OR = 1.37 (95% CI: 1.12–1.68, for 1 unit of the HASI, lag 3). Conclusions The proposed index (HASI) allows to confirm the pattern of associations for lags obtained for individual air pollutants. In the presented example the used index (HASI) indicates the strongest relation with the exposure lagged by 3 days.

Air pollution and emergency department visits for conjunctivitis: A case-crossover study

100%

Szyszkowicz M., Kousha T., Castner J.

International Journal of Occupational Medicine and Environmental Health

2016

vol. 29

issue 3

381-393

Objectives The purpose of this study was to examine the associations between emergency department (ED) visits for conjunctivitis and ambient air pollution levels in urban regions across the province of Ontario, Canada. Material and Methods Information from the National Ambulatory Care Reporting System was used to create time-series records, for the period of April 2004 to December 2011, on emergency department visits of patients suffering from conjunctivitis. A total of 77 439 emergency department visits for conjunctivitis were analyzed. A time-stratified case-crossover design was applied, completed with meta-analysis in order to pool inter-city results. Odds ratio (OR) for an emergency department visit was calculated in different population strata per one-unit increase (one interquartile range – IQR increase in a pollutant’s daily level) while controlling for the impacts of temperature and relative humidity. Results Statistically significant positive results were observed in the female population sample, for nitrogen dioxide (NO₂) exposure lagged 5–8 days, with the highest result for the 7-day lag (OR = 1.035, 95% CI: 1.018–1.052) and for fine particulate matter with a median aerodynamic diameter of less than 2.5 μm ($\text{PM}_\text{2.5}$), for lags 6 and 7 days, with the highest result for lag 7 (OR = 1.017, 95% CI: 1.003–1.031). In the male population sample, statistically significant positive results were observed for NO₂ at lag 5 days (OR = 1.024, 95% CI: 1.004–1.045) and for ozone (O₃), at lags 0–3 and 7 days, with the highest result for lag 0 (OR = 1.038, 95% CI: 1.012–1.056). Also for males, statistically significant results were observed in the case of $\text{PM}_\text{2.5}$ exposure lagged by 5 days (OR = 1.003, 95% CI: 1.000–1.038) and sulfur dioxide (SO₂) exposure lagged by 1 and 2 days (OR = 1.016, 95% CI: 1.000–1.031 and OR = 1.018, 95% CI: 1.002–1.033). Conclusions The findings of this study suggest that there are associations between levels of air pollution and ED visits for conjunctivitis, with different temporal trends and strength of association by age, sex, and season.

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2 International Journal of Occupational Medicine and Environmental Health

2 Szyszkowicz M.

1 Castner J.

1 Kousha T.

1 2016

1 2015

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An approach to represent a combined exposure to air pollution

Air pollution and emergency department visits for conjunctivitis: A case-crossover study