The effect of ozone and PM10 on hospital admissions for pneumonia and chronic obstructive pulmonary disease: a national multicity study.

A case-crossover study was conducted in 36 US cities to evaluate the effect of ozone and particulate matter with an aerodynamic diameter of < or =10 microm (PM10) on respiratory hospital admissions and to identify which city characteristics may explain the heterogeneity in risk estimates. Respiratory hospital admissions and air pollution data were obtained for 1986-1999. In a meta-analysis based on the city-specific regression models, several city characteristics were evaluated as effect modifiers. During the warm season, the 2-day cumulative effect of a 5-ppb increase in ozone was a 0.27% (95% confidence interval (CI): 0.08, 0.47) increase in chronic obstructive pulmonary disease admissions and a 0.41% (95% CI: 0.26, 0.57) increase in pneumonia admissions. Similarly, a 10-microg/m(3) increase in PM10 during the warm season resulted in a 1.47% (95% CI: 0.93, 2.01) increase in chronic obstructive pulmonary disease at lag 1 and a 0.84% (95% CI: 0.50, 1.19) increase in pneumonia at lag 0. Percentage of households with central air conditioning reduced the effect of air pollution, and variability of summer apparent temperature reduced the effect of ozone on chronic obstructive pulmonary disease. The study confirmed, in a large sample of cities, that exposure to ozone and PM10 is associated with respiratory hospital admissions and provided evidence that the effect of air pollution is modified by certain city characteristics.

[1]  Thomas Lumley,et al.  Referent Selection in Case-Crossover Analyses of Acute Health Effects of Air Pollution , 2001, Epidemiology.

[2]  D Krewski,et al.  Association between ozone and hospitalization for respiratory diseases in 16 Canadian cities. , 1997, Environmental research.

[3]  Kaijie Fang,et al.  Effects of Inhaled Ambient Particulate Matter on Pulmonary Antimicrobial Immune Defense , 2003, Inhalation toxicology.

[4]  J. Sarnat,et al.  Fine particulate air pollution and mortality in 20 U.S. cities. , 2001, The New England journal of medicine.

[5]  J. Schwartz,et al.  Assessing confounding, effect modification, and thresholds in the association between ambient particles and daily deaths. , 2000, Environmental health perspectives.

[6]  D. Costa,et al.  Bioavailable transition metals in particulate matter mediate cardiopulmonary injury in healthy and compromised animal models. , 1997, Environmental health perspectives.

[7]  J. Schwartz.  Is the association of airborne particles with daily deaths confounded by gaseous air pollutants? An approach to control by matching. , 2003, Environmental health perspectives.

[8]  Rebecca Bascom,et al.  Health effects of outdoor air pollution , 1996 .

[9]  Michelle L. Bell,et al.  A Meta-Analysis of Time-Series Studies of Ozone and Mortality With Comparison to the National Morbidity, Mortality, and Air Pollution Study , 2005, Epidemiology.

[10]  R. G. Steadman,et al.  The Assessment of Sultriness. Part II: Effects of Wind, Extra Radiation and Barometric Pressure on Apparent Temperature , 1979 .

[11]  S L Zeger,et al.  The National Morbidity, Mortality, and Air Pollution Study. Part I: Methods and methodologic issues. , 2000, Research report.

[12]  Kazuhiko Ito,et al.  A multi-year study of air pollution and respiratory hospital admissions in three New York State metropolitan areas: results for 1988 and 1989 summers. , 1992, Journal of exposure analysis and environmental epidemiology.

[13]  J. Schwartz,et al.  Short-term effects of air pollution on hospital admissions of respiratory diseases in Europe: a quantitative summary of APHEA study results. Air Pollution and Health: a European Approach. , 1998, Archives of environmental health.

[14]  J. Schwartz.  How sensitive is the association between ozone and daily deaths to control for temperature? , 2005, American journal of respiratory and critical care medicine.

[15]  Health effects of outdoor air pollution. Committee of the Environmental and Occupational Health Assembly of the American Thoracic Society. , 1996, American journal of respiratory and critical care medicine.

[16]  Eger,et al.  Fine particulate air pollution and mortality in 20 U.S. cities, 1987-1994. , 2000, The New England journal of medicine.

[17]  J. Schwartz,et al.  Short term effects of particulate matter on cause specific mortality: effects of lags and modification by city characteristics , 2005, Occupational and Environmental Medicine.

[18]  T. Bateson,et al.  Selection Bias and Confounding in Case-Crossover Analyses of Environmental Time-Series Data , 2001, Epidemiology.

[19]  T. Bateson,et al.  Control for seasonal variation and time trend in case-crossover studies of acute effects of environmental exposures. , 1999, Epidemiology.

[20]  Laurence S. Kalkstein,et al.  An Evaluation of Summer Discomfort in the United State Using a Relative Climatological Index , 1986 .

[21]  Antonella Zanobetti,et al.  Air conditioning and source-specific particles as modifiers of the effect of PM(10) on hospital admissions for heart and lung disease. , 2001, Environmental health perspectives.

[22]  J. Schwartz,et al.  Acute effects of particulate air pollution on respiratory admissions: results from APHEA 2 project. Air Pollution and Health: a European Approach. , 2001, American journal of respiratory and critical care medicine.

[23]  L. Wallace,et al.  Indoor particles: a review. , 1996, Journal of the Air & Waste Management Association.

[24]  F. Dominici,et al.  Seasonal analyses of air pollution and mortality in 100 US cities. , 2005, American journal of epidemiology.

[25]  J. Schwartz,et al.  Air pollution and daily admissions for chronic obstructive pulmonary disease in 6 European cities: results from the APHEA project. , 1997, The European respiratory journal.

[26]  L. Folinsbee,et al.  Prediction of ozone-induced FEV1 changes. Effects of concentration, duration, and ventilation. , 1997, American journal of respiratory and critical care medicine.

[27]  Gerald J. Nehls,et al.  Procedures for Handling Aerometric Data , 1973 .

[28]  J Schwartz,et al.  Airborne particles are a risk factor for hospital admissions for heart and lung disease. , 2000, Environmental health perspectives.

[29]  P. Koutrakis,et al.  Personal exposures to acid aerosols and ammonia , 1992 .

[30]  J. Schwartz,et al.  Association of fine particulate matter from different sources with daily mortality in six U.S. cities. , 2000, Environmental health perspectives.

[31]  Joel Schwartz,et al.  REVIEW OF EPIDEMIOLOGICAL EVIDENCE OF HEALTH EFFECTS OF PARTICULATE AIR POLLUTION , 1995 .

[32]  H. R. Anderson,et al.  Particulate air pollution and hospital admissions for cardiorespiratory diseases: are the elderly at greater risk? , 2003, European Respiratory Journal.

[33]  M. Maclure.  The case-crossover design: a method for studying transient effects on the risk of acute events. , 1991, American journal of epidemiology.

[34]  D Krewski,et al.  Effects of low ambient levels of ozone and sulfates on the frequency of respiratory admissions to Ontario hospitals. , 1994, Environmental research.

[35]  Brent Coull,et al.  Rapid increases in the steady-state concentration of reactive oxygen species in the lungs and heart after particulate air pollution inhalation. , 2002, Environmental health perspectives.

[36]  J. Schwartz,et al.  Short-term effects of air pollution on hospital admissions of respiratory diseases in Europe: a quantitative summary of APHEA study results. Air Pollution and Health: a European Approach. , 1998, Archives of environmental health.

[37]  B. Brunekreef,et al.  Air pollution and health , 2002, The Lancet.

[38]  M. Corradi,et al.  Biomarkers of oxidative stress after controlled human exposure to ozone. , 2002, Toxicology letters.

[39]  W. MacNee,et al.  Histone acetylation regulates epithelial IL-8 release mediated by oxidative stress from environmental particles. , 2003, American journal of physiology. Lung cellular and molecular physiology.

[40]  J. Schwartz,et al.  The National Morbidity, Mortality, and Air Pollution Study. Part II: Morbidity and mortality from air pollution in the United States. , 2000, Research report.

[41]  S. Sharp,et al.  Explaining heterogeneity in meta-analysis: a comparison of methods. , 1999 .

[42]  Yuanzhang Li,et al.  Assessment of recent ozone short-term epidemiologic studies. , 2001, Inhalation toxicology.