title: Fine particulate air pollution, nitrogen dioxide, and systemic autoimmune rheumatic disease in Calgary, Alberta.
abstract: OBJECTIVE
  To estimate the association between fine particulate (PM2.5) and nitrogen dioxide (NO2) pollution and systemic autoimmune rheumatic diseases (SARDs).
  
  
  METHODS
  Associations between ambient air pollution (PM2.5 and NO2) and SARDs were assessed using land-use regression models for Calgary, Alberta and administrative health data (1993-2007). SARD case definitions were based on ≥2 physician claims, or ≥1 rheumatology billing code; or ≥1 hospitalization code (for systemic lupus, Sjogren's Syndrome, scleroderma, polymyositis, dermatomyositis, or undifferentiated connective tissue disease). Bayesian hierarchical latent class regression models estimated the probability that each resident was a SARD case, based on these case definitions. The sum of individual level probabilities provided the estimated number of cases in each area. The latent class model included terms for age, sex, and an interaction term between age and sex. Bayesian logistic regression models were used to generate adjusted odds ratios (OR) for NO2 and PM2.5. pollutant models, adjusting for neighbourhood income, age, sex, and an interaction between age and sex. We also examined models stratified for First-Nations (FN) and non-FN subgroups.
  
  
  RESULTS
  Residents that were female and/or aged >45 had a greater probability of being a SARD case, with the highest OR estimates for older females. Independently, the odds of being a SARDs case increased with PM2.5 levels, but the results were inconclusive for NO2. The results stratified by FN and non-FN groups were not distinctly different.
  
  
  CONCLUSIONS
  In this urban Canadian sample, adjusting for demographics, exposure to PM2.5 was associated with an increased risk of SARDs. The results for NO2 were inconclusive.
authors.affiliation: Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada. Electronic address: sasha.bernatsky@mcgill.ca.
authors.forename: Sasha
authors.initials: S
authors.lastname: Bernatsky
authors.affiliation: Département de Santé Environnementale et de Santé au Travail, Université de Montréal, Montreal, Quebec, Canada; Institut National de Santé Publique du Québec, Montréal, Canada.
authors.forename: Audrey
authors.initials: A
authors.lastname: Smargiassi
authors.affiliation: Air Health Science Division, Health Canada, Ottawa, Ontario, Canada.
authors.forename: Markey
authors.initials: M
authors.lastname: Johnson
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Gilaad G
authors.initials: GG
authors.lastname: Kaplan
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Canada; Surveillance and Assessment, Alberta Ministry of Health, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Albert, Canada; University of Alberta, School of Public Health, Edmonton, Alberta, Canada.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Barnabe
authors.affiliation: Department of Community Health Sciences, University of Calgary, Canada; Surveillance and Assessment, Alberta Ministry of Health, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Albert, Canada; University of Alberta, School of Public Health, Edmonton, Alberta, Canada.
authors.forename: Larry
authors.initials: L
authors.lastname: Svenson
authors.affiliation: Département de Santé Environnementale et de Santé au Travail, Université de Montréal, Montreal, Quebec, Canada; Institut National de Santé Publique du Québec, Montréal, Canada.
authors.forename: Allan
authors.initials: A
authors.lastname: Brand
authors.affiliation: Department of Geography, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Stefania
authors.initials: S
authors.lastname: Bertazzon
authors.affiliation: Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Rheumatology, Jewish General Hospital, Montréal, Quebec, Canada.
authors.forename: Marie
authors.initials: M
authors.lastname: Hudson
authors.affiliation: Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Allergy and Clinical Immunology, McGill University Health Centre, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
authors.forename: Ann E
authors.initials: AE
authors.lastname: Clarke
authors.affiliation: Division of Rheumatology, Department of Medicine, Université Laval, Quebec city, Quebec, Canada.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Fortin
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Canada; Surveillance and Assessment, Alberta Ministry of Health, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Albert, Canada; University of Alberta, School of Public Health, Edmonton, Alberta, Canada.
authors.forename: Steven
authors.initials: S
authors.lastname: Edworthy
authors.affiliation: Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Patrick
authors.initials: P
authors.lastname: Bélisle
authors.affiliation: Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Joseph
mesh_terms: D000416:Alberta; D001327:Autoimmune Diseases / Q000139:chemically induced*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009585:Nitrogen Dioxide / Q000633:toxicity*; D052638:Particulate Matter / Q000633:toxicity*; D012216:Rheumatic Diseases / Q000139:chemically induced*
chemical_list: D052638:Particulate Matter; D009585:Nitrogen Dioxide
keywords: Air pollution; Systemic autoimmune rheumatic diseases