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Environ Health. 2016 Nov 25;15(1):115.

Pediatric emergency department visits and ambient Air pollution in the U.S. State of Georgia: a case-crossover study.

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Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Department of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA, USA.
School of Community Health Sciences, University of Nevada - Reno, 1664 N Virginia Street MS 0274, Reno, NV, 89557, USA.
School of Community Health Sciences, University of Nevada - Reno, 1664 N Virginia Street MS 0274, Reno, NV, 89557, USA.



Estimating the health effects of ambient air pollutant mixtures is necessary to understand the risk of real-life air pollution exposures.


Pediatric Emergency Department (ED) visit records for asthma or wheeze (n = 148,256), bronchitis (n = 84,597), pneumonia (n = 90,063), otitis media (n = 422,268) and upper respiratory tract infection (URI) (n = 744,942) were obtained from Georgia hospitals during 2002-2008. Spatially-contiguous daily concentrations of 11 ambient air pollutants were estimated from CMAQ model simulations that were fused with ground-based measurements. Using a case-crossover study design, odds ratios for 3-day moving average air pollutant concentrations were estimated using conditional logistic regression, matching on ZIP code, day-of-week, month, and year.


In multipollutant models, the association of highest magnitude observed for the asthma/wheeze outcome was with "oxidant gases" (O3, NO2, and SO2); the joint effect estimate for an IQR increase of this mixture was OR: 1.068 (95% CI: 1.040, 1.097). The group of "secondary pollutants" (O3 and the PM2.5 components SO42-, NO3-, and NH4+) was strongly associated with bronchitis (OR: 1.090, 95% CI: 1.050, 1.132), pneumonia (OR: 1.085, 95% CI: 1.047, 1.125), and otitis media (OR: 1.059, 95% CI: 1.042, 1.077). ED visits for URI were strongly associated with "oxidant gases," "secondary pollutants," and the "criteria pollutants" (O3, NO2, CO, SO2, and PM2.5).


Short-term exposures to air pollution mixtures were associated with ED visits for several different pediatric respiratory diseases.


Air pollution; CMAQ; Multipollutant model; Pediatric Emergency Department Visits

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