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  • Original Article
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Ambient air pollution and emergency department visits for asthma: a multi-city assessment of effect modification by age


Previous studies have found strong associations between asthma morbidity and major ambient air pollutants. Relatively little research has been conducted to assess whether age is a factor conferring susceptibility to air pollution-related asthma morbidity. We investigated the short-term relationships between asthma emergency department (ED) visits and ambient ozone (O3), carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), and fine particulate matter (PM2.5) in Atlanta (1993–2009), Dallas (2006–2009), and St. Louis (2001–2007). City-specific daily time-series analyses were conducted to estimate associations by age group (0–4, 5–18, 19–39, 40–64, and 65+ years). Sub-analyses were performed stratified by race and sex. City-specific rate ratios (RRs) were combined by inverse-variance weighting to provide an overall association for each strata. The overall RRs differed across age groups, with associations for all pollutants consistently strongest for children aged 5–18 years. The patterns of association across age groups remained generally consistent when models were stratified by sex and race, although the strong observed associations among 5–18 year olds appeared to be partially driven by non-white and male patients. Our findings suggest that age is a susceptibility factor for asthma exacerbations in response to air pollution, with school-age children having the highest susceptibility.

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The authors would like to acknowledge the contributions of members of the Southeastern Center for Air Pollution and Epidemiology (SCAPE) research group, particularly Paige Tolbert, for their thoughtful feedback on data analysis approaches and results interpretation. This publication is based in part upon information obtained through the Dallas Fort Worth Hospital Council Foundation Information and Quality Services Center’s collaborative hospital data initiative, the Georgia Hospital Association, and the Missouri Hospital Association. We are grateful for the support of all participating hospitals. This work was supported by a Clean Air Research Center grant to Emory University and the Georgia Institute of Technology from the US Environmental Protection Agency (USEPA, grant RD834799). This publication was also made possible by grants to Emory University from the USEPA (grant R82921301-0), the National Institutes of Health (grant 5T32ES012160), the National Institute of Environmental Health Sciences (grant R01ES11294), and the Electric Power Research Institute (grants EP-P27723/C13172, EP-P4353/C2124, EP-P34975/C15892, EP-P45572/C19698, and EP-P25912/C12525). The content of this publication is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the USEPA. Further, USEPA does not endorse the purchase of any commercial products or services mentioned in the publication.

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Correspondence to Brooke A Alhanti.

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Supplementary Information accompanies the paper on the Journal of Exposure Science and Environmental Epidemiology website

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Alhanti, B., Chang, H., Winquist, A. et al. Ambient air pollution and emergency department visits for asthma: a multi-city assessment of effect modification by age. J Expo Sci Environ Epidemiol 26, 180–188 (2016).

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