Exposure to urban air pollution and emergency department visits for diseases of the ear and mastoid processes

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DOI

https://doi.org/10.1016/j.apr.2021.101198

Language of the publication
English
Date
2021-09-13
Type
Article
Author(s)
  • Lukina, Anna O.
  • Maquiling, Aubrey
  • Burstein, Brett
  • Szyszkowicz, Mieczysław
Publisher
Elsevier

Abstract

Exposure to ambient air pollutants may cause adverse health effects. This study sought to assess the association of five major air pollutants concentration levels and number of Emergency Department (ED) visits for ear and mastoid pathology in the large Canadian urban city, Toronto. A time-stratified case-crossover study design was used for the period between April 1, 2004 and December 31, 2015. Daily air pollution data were collected from the National Air Pollution Surveillance Database for carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), ground-level ozone (O3) and fine particulate matter (PM2.5). Data were also collected for weather variables. ED visit data were extracted from the National Ambulatory Care Reporting System database. Conditional Poisson models were applied using daily counts of the ED visits. Temperature and relative humidity in the models were represented by natural splines. Independent variables (air pollutants and weather conditions) were lagged by the same number of exposure days, from 0 to 14. The analyses were grouped by strata according to patients’ sex and age, also by seasons. For each studied pollutant, 270 models were derived (15 lags × 18 strata). There were 188,997 ED visits during the 140-month study period. Children under 10 years represented 31.7% of all visits, compared to 53.8% for patients aged 11–60 years, and 14.5% for those above 60 years. Short-term (time lags 4 and 5 days) NO2 exposure was positively associated with number of ED visits for ear and mastoid pathology for children independent of sex. Boys had relative risks (RR) of 1.030 (95% confidence intervals: 1.009–1.053) and 1.033 (1.011–1.055) for ED visits on days 4 and 5 after exposure to NO2 by one interquartile range (IQR = 8.8 ppb), respectively. Girls had RR of 1.046 (1.021–1.071) and 1.039 (1.014–1.064) on days 4 and 5 after exposure to NO2 by the same IQR, respectively. For lag 4, a one unit increase in the calculated air quality health index results in a 1.038 (1.020–1.057), 1.042 (1.017–1.067), and 1.036 (1.014–1.058), for all children, girls, and boys, respectively. In this large urban cohort, number of ED visits for ear and/or mastoid process infections peaked in the acute period following elevated overall air pollution and NO2 specifically, especially among young children.

Plain language summary

Health Canada's is responsible for assessing and managing any potential health risks to Canadians arising from exposure to environmental pollutants. Exposure to outdoor air pollution is known to cause adverse health effects, including respiratory diseases. In this study, all possible associations between exposure to five major air pollutants and emergency rooms visits related to ear and mastoid pathology were examined across age groups of Toronto residents, from April 1, 2004- December 31, 2015. In the entire period of the study, a total of 188,997 emergency room visits were recorded. Children under 10 years represented 31.7% of all visits, compared to 53.8% for patients aged 11-60 years, and 14.5% for those above 60 years. We found more consistent positive association between short-term exposure to nitrogen dioxide (NO2) and emergency room visits among young children under 10 years, especially when exposed for a minimum of four-five days. No difference in sex and seasonality (cold: October-March and warm: April-September) was found. Even at low levels of such air pollutant, arising mostly from combustion processes and high volumes of traffic in large urban setting, appear to contribute to more frequent emergency room visits related to ear and mastoid pathology.

Subject

  • Health,
  • Health and safety

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