Pediatric patient asthma-related emergency department visits and admissions in Washington, DC, from 2001–2004, and associations with air quality, socio-economic status and age group

Lee, Babin, Burkom, Holtry, Tabernero, Stokes, Davies-Cole, Dehaan Kerda

Description

The District of Columbia (DC) Department of Health, under a grant from the US Centers for Disease Control and Prevention, established an Environmental Public Health Tracking Program. As part of this program, the goals of this contextual pilot study are to quantify short-term associations between daily pediatric emergency department (ED) visits and admissions for asthma exacerbations with ozone and particulate concentrations, and broader associations with socio-economic status and age group. Methods Data included daily counts of de-identified asthma-related pediatric ED visits for DC residents and daily ozone and particulate concentrations during 2001–2004. Daily temperature, mold, and pollen measurements were also obtained. After a cubic spline was applied to control for long-term seasonal trends in the ED data, a Poisson regression analysis was applied to the time series of daily counts for selected age groups. Results Associations between pediatric asthma ED visits and outdoor ozone concentrations were significant and strongest for the 5–12 year-old age group, for which a 0.01-ppm increase in ozone concentration indicated a mean 3.2% increase in daily ED visits and a mean 8.3% increase in daily ED admissions. However, the 1–4 yr old age group had the highest rate of asthma-related ED visits. For 1–17 yr olds, the rates of both asthma-related ED visits and admissions increased logarithmically with the percentage of children living below the poverty threshold, slowing when this percentage exceeded 30%. Conclusion Significant associations were found between ozone concentrations and asthma-related ED visits, especially for 5–12 year olds. The result that the most significant ozone associations were not seen in the age group (1–4 yrs) with the highest rate of asthma-related ED visits may be related to the clinical difficulty in accurately diagnosing asthma among this age group. We observed real increases in relative risk of asthma ED visits for children living in higher poverty zip codes versus other zip codes, as well as similar logarithmic relationships for visits and admissions, which implies ED over-utilization may not be a factor. These results could suggest designs for future epidemiological studies that include more information on individual exposures and other risk factors.

Informations

• Publié par: biomed
• Publié le: 01 janvier 2007
• Nombre de lectures: 5
• Langue: English

Extrait

Environmental Health

BioMedCentral

Open Access Research Pediatric patient asthma-related emergency department visits and admissions in Washington, DC, from 2001–2004, and associations with air quality, socio-economic status and age group 1 1 1 Steven M Babin* , Howard S Burkom , Rekha S Holtry , 1 2,3 2 Nathaniel R Tabernero , Lynette D Stokes , John O DaviesCole , 2 2,4 Kerda DeHaan and Deitra H Lee

1 2 Address: Johns Hopkins University, Applied Physics Laboratory, 11100 Johns Hopkins Road, Laurel, MD 20723, USA, Environmental Public Health Tracking Program, Bureau of Epidemiology and Health Risk Assessment, District of Columbia Department of Health, 825 North Capitol 3 Street NE, 3rd Floor, Washington, DC 20002, USA, Currently employed by the Division of Energy Employees Occupational Illness 4 Compensation, US Department of Labor, Washington, DC 20210, USA and Currently employed by the US Government Accountability Office, Washington, DC 20548, USA Email: Steven M Babin*  [e-mail]; Howard S Burkom  [e-mail]; Rekha S Holtry  [e-mail]; Nathaniel R Tabernero  [e-mail]; Lynette D Stokes  [e-mail]; John O DaviesCole  john.davies[e-mail]; Kerda DeHaan  [e-mail]; Deitra H Lee  [e-mail] * Corresponding author

Published: 21 March 2007 Received: 10 August 2006 Accepted: 21 March 2007 Environmental Health2007,6:9 doi:10.1186/1476-069X-6-9 This article is available from: http://www.ehjournal.net/content/6/1/9 © 2007 Babin et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract Background:The District of Columbia (DC) Department of Health, under a grant from the US Centers for Disease Control and Prevention, established an Environmental Public Health Tracking Program. As part of this program, the goals of this contextual pilot study are to quantify short-term associations between daily pediatric emergency department (ED) visits and admissions for asthma exacerbations with ozone and particulate concentrations, and broader associations with socio- economic status and age group. Methods:Data included daily counts of de-identified asthma-related pediatric ED visits for DC residents and daily ozone and particulate concentrations during 2001–2004. Daily temperature, mold, and pollen measurements were also obtained. After a cubic spline was applied to control for long-term seasonal trends in the ED data, a Poisson regression analysis was applied to the time series of daily counts for selected age groups. Results:Associations between pediatric asthma ED visits and outdoor ozone concentrations were significant and strongest for the 5–12 year-old age group, for which a 0.01-ppm increase in ozone concentration indicated a mean 3.2% increase in daily ED visits and a mean 8.3% increase in daily ED admissions. However, the 1–4 yr old age group had the highest rate of asthma-related ED visits. For 1–17 yr olds, the rates of both asthma-related ED visits and admissions increased logarithmically with the percentage of children living below the poverty threshold, slowing when this percentage exceeded 30%. Conclusion:Significant associations were found between ozone concentrations and asthma- related ED visits, especially for 5–12 year olds. The result that the most significant ozone

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