Abstract
Although short-term exposure to ambient ozone (O3) can cause poor respiratory health outcomes, the shape of the concentration-response (C-R) between O3 and respiratory morbidity has not been widely investigated. We estimated the effect of daily O3 on emergency department (ED) visits for selected respiratory outcomes in 5 US cities under various model assumptions and assessed model fit. Population-weighted average 8-h maximum O3 concentrations were estimated in each city. Individual-level data on ED visits were obtained from hospitals or hospital associations. Poisson log-linear models were used to estimate city-specific associations between the daily number of respiratory ED visits and 3-day moving average O3 levels controlling for long-term trends and meteorology. Linear, linear-threshold, quadratic, cubic, categorical, and cubic spline O3 C-R models were considered. Using linear C-R models, O3 was significantly and positively associated with respiratory ED visits in each city with rate ratios of 1.02–1.07 per 25 ppb. Models suggested that O3-ED C-R shapes were linear until O3 concentrations of roughly 60 ppb at which point risk continued to increase linearly in some cities for certain outcomes while risk flattened in others. Assessing C-R shape is necessary to identify the most appropriate form of the exposure for each given study setting.
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References
Ji M, Cohan DS, Bell ML. Meta-analysis of the association between short-term exposure to ambient ozone and respiratory hospital admissions. Environ Res Lett. 2011;6:024006.
Bell ML, Dominici F, Samet JM. A meta-analysis of time-series studies of ozone and mortality with comparison to the national morbidity, mortality, and air pollution study. Epidemiology. 2005;16:436–45.
EPA US. Integrated Science Assessment for Ozone and Related Photochemical Oxidants. 2013;1–6.
Atkinson RW, Yu D, Armstrong BG, Pattenden S, Wilkinson P, Doherty RM, et al. Concentration-response function for ozone and daily mortality: results from five urban and five rural U.K. populations. Environ Health Perspect. 2012;120:1411–7.
Bae S, Lim YH, Kashima S, Yorifuji T, Honda Y, Kim H, et al. Non-linear concentration-response relationships between ambient ozone and daily mortality. PLoS ONE. 2015;10:e0129423.
Bell ML, Peng RD, Dominici F. The exposure-response curve for ozone and risk of mortality and the adequacy of current ozone regulations. Environ Health Perspect. 2006;114:532–6.
Gryparis A, Forsberg B, Katsouyanni K, Analitis A, Touloumi G, Schwartz J, et al. Acute effects of ozone on mortality from the “air pollution and health: a European approach” project. Am J Respir Crit Care Med. 2004;170:1080–7.
Hoek G, Schwartz JD, Groot B, Eilers P. Effects of ambient particulate matter and ozone on daily mortality in Rotterdam, The Netherlands. Arch Environ Health. 1997;52:455–63.
Kim SY, Lee JT, Hong YC, Ahn KJ, Kim H. Determining the threshold effect of ozone on daily mortality: an analysis of ozone and mortality in Seoul, Korea, 1995-1999. Environ Res. 2004;94:113–9.
Moolgavkar SH. Air pollution and daily mortality in two U.S. counties: season-specific analyses and exposure-response relationships. Inhal Toxicol. 2003;15:877–907.
Touloumi G, Katsouyanni K, Zmirou D, Schwartz J, Spix C, de Leon AP, et al. Short-term effects of ambient oxidant exposure on mortality: a combined analysis within the APHEA project. Air pollution and health: a European approach. Am J Epidemiol. 1997;146:177–85.
Medina-Ramon M, Schwartz J. Who is more vulnerable to die from ozone air pollution? Epidemiology. 2008;19:672–9.
Akinbami LJ, Moorman JE, Lin X. Asthma prevalence, health care use, and mortality: United States, 2005-2009. Natl Health Stat Report. 2011;32:1–14.
Vancza EM, Galdanes K, Gunnison A, Hatch G, Gordon T. Age, strain, and gender as factors for increased sensitivity of the mouse lung to inhaled ozone. Toxicol Sci. 2009;107:535–43.
Bateson TF, Schwartz J. Children’s response to air pollutants. J Toxicol Environ Health A. 2008;71:238–43.
Rudd RA, Moorman JE. Asthma incidence: data from the National Health Interview Survey, 1980–96. J Asthma. 2007;44:65–70.
Levy JI. Issues and uncertainties in estimating the health benefits of air pollution control. J Toxicol Environ Health A. 2003;66:1865–71.
Alhanti BA, Chang HH, Winquist A, Mulholland JA, Darrow LA, Sarnat SE. Ambient air pollution and emergency department visits for asthma: a multi-city assessment of effect modification by age. J Expo Sci Environ Epidemiol. 2016;26:180–8.
Krall JR, Mulholland JA, Russell AG, Balachandran S, Winquist A, Tolbert PE, et al. Associations between source-specific fine particulate matter and emergency department visits for respiratory disease in four U.S. cities. Environ Health Perspect. 2017;125:97–103.
O’Lenick C, Chang HH, Kramer MR, Winquist A, Mulholland JA, Friberg MD, et al. Ozone and childhood respiratory disease in three US cities: evaluation of effect measure modification by neighborhood socioeconomic status using a Bayesian hierarchical approach. Environ Health. 2017;16:36.
Friberg MD, Kahn RA, Holmes HA, Chang HH, Sarnat SE, Tolbert PE, et al. Daily ambient air pollution metrics for five cities: Evaluation of data-fusion-based estimates and uncertainties. Atmos Environ. 2017;158:36–50.
Friberg MD, Zhai X, Holmes HA, Chang HH, Strickland MJ, Sarnat SE, et al. Method for fusing observational data and chemical transport model simulations to estimate spatiotemporally resolved ambient air pollution. Environ Sci Technol. 2016;50:3695–705.
Ivy D, Mulholland JA, Russell AG. Development of ambient air quality population-weighted metrics for use in time-series health studies. J Air Waste Manag Assoc. 2008;58:711–20.
Rothman, K, & Greenland, S. Introduction to stratified analysis, testing homogeneity. In: Wilkins LWa, editor. Modern epidemiology, 2nd edn. Philadelphia, PA: Lippincott Williams & Wilkins; 1998. p. 275.
Flanders WD, Klein M, Darrow LA, Strickland MJ, Sarnat SE, Sarnat JA, et al. A method for detection of residual confounding in time-series and other observational studies. Epidemiology. 2011;22:59–67.
Fiore A, Jacob DJ, Liu H, Yantosca RM, Fairlie TD, Li Q. Variability in surface ozone background over the United States: Implications for air quality policy. J Geophys Res Atmos. 2003;108(D24):n/a–n/a.
Franklin M, Zeka A, Schwartz J. Association between PM2.5 and all-cause and specific-cause mortality in 27 US communities. J Expo Sci Environ Epidemiol. 2007;17:279–87.
Bell ML, Ebisu K, Peng RD, Dominici F. Adverse health effects of particulate air pollution: modification by air conditioning. Epidemiology. 2009;20:682–6.
Lippmann M. Effects of ozone on respiratory function and structure. Annu Rev Public Health. 1989;10:49–67.
Armstrong B. Models for the relationship between ambient temperature and daily mortality. Epidemiology. 2006; 2006: 624–31.
Cakmak S, Burnett RT, Krewski D. Methods for detecting and estimating population threshold concentrations for air pollution-related mortality with exposure measurement error. Risk Anal. 1999;19:487–96.
Daniels MJ, Dominici F, Zeger SL, Samet JM. The National Morbidity, Mortality, and Air Pollution Study. Part III: PM10 concentration-response curves and thresholds for the 20 largest US cities. Res Rep Health Eff Inst 2004; (94 Pt 3):1–21; discussion 3–30.
Dominici F, Sheppard L, Clyde M. Health effects of air pollution: a statistical review. Int Stat Rev. 2003;71:243–76.
May S, Bigelow C. Modeling nonlinear dose-response relationships in epidemiologic studies: statistical approaches and practical challenges. Dose-response: a publication of International Hormesis. Society. 2005;3:474–90.
Samoli E, Touloumi G, Zanobetti A, Le Tertre A, Schindler C, Atkinson R, et al. Investigating the dose-response relation between air pollution and total mortality in the APHEA-2 multicity project. Occup Environ Med. 2003;60:977–82.
Lepeule J, Laden F, Dockery D, Schwartz J. Chronic exposure to fine particles and mortality: an extended follow-up of the Harvard Six Cities study from 1974 to 2009. Environ Health Perspect. 2012;120:965–70.
Zeger SL, Thomas D, Dominici F, Samet JM, Schwartz J, Dockery D, et al. Exposure measurement error in time-series studies of air pollution: concepts and consequences. Environ Health Perspect. 2000;108:419–26.
Strickland MJ, Gass KM, Goldman GT, Mulholland JA. Effects of ambient air pollution measurement error on health effect estimates in time-series studies: a simulation-based analysis. J Expo Sci Environ Epidemiol. 2015;25:160–6.
Sarnat SE, Klein M, Sarnat JA, Flanders WD, Waller LA, Mulholland JA, et al. An examination of exposure measurement error from air pollutant spatial variability in time-series studies. J Expo Sci Environ Epidemiol. 2010;20:135–46.
Sarnat SE, Sarnat JA, Mulholland J, Isakov V, Ozkaynak H, Chang HH, et al. Application of alternative spatiotemporal metrics of ambient air pollution exposure in a time-series epidemiological study in Atlanta. J Expo Sci Environ Epidemiol. 2013;23:593–605.
Acknowledgements
This publication is based in part upon information obtained through the Georgia Hospital Association, the Missouri Hospital Association, the Dallas Fort Worth Hospital Council Foundation Information and Quality Services Center’s collaborative hospital data initiative, and individual hospitals and hospital systems in Birmingham and Pittsburgh. We are grateful for the support of all participating hospitals. This publication was developed under Assistance Agreement No. EPA834799 awarded by the US Environmental Protection Agency (USEPA) to Emory University and Georgia Institute of Technology as well as by funding from the Electric Power Research Institute (EPRI, 10002467). Research reported in this publication was also supported by grants to Emory University from the USEPA (R82921301), the National Institute of Environmental Health Sciences (R01ES11294), and EPRI (EP-P27723/C13172, EP-P4353/C2124, EP-P34975/C15892, EP-P45572/C19698, and EP-P25912/C12525). This publication has not been formally reviewed by USEPA or NIH. The views expressed in this document are solely those of the authors and do not necessarily reflect those of either Agency. USEPA does not endorse any products or commercial services mentioned in this publication.
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Barry, V., Klein, M., Winquist, A. et al. Characterization of the concentration-response curve for ambient ozone and acute respiratory morbidity in 5 US cities. J Expo Sci Environ Epidemiol 29, 267–277 (2019). https://doi.org/10.1038/s41370-018-0048-7
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DOI: https://doi.org/10.1038/s41370-018-0048-7
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