title: The Air Quality Health Index and Emergency Department Visits for Otitis Media.
abstract: OBJECTIVE
  The purpose of this study was to explore novel multipollutant exposure assessments using the Air Quality Health Index in relation to emergency department visits for otitis media (OM).
  
  
  METHODS
  This study was a retrospective analysis using information from emergency department visits for OM, air pollution, and weather databases.
  
  
  METHODS
  For children 3 years of age or younger, there were 4,815 emergency department visits for OM over a 6-year period across hospitals in Windsor, Ontario, Canada. Both time-stratified case-crossover and nonlinear time series distributed lag analyses were applied to investigate the association between the Air Quality Health Index and visits for OM.
  
  
  RESULTS
  Using case-crossover analysis, there was an increase in emergency department visits with OM diagnoses 6 to 7 days postexposure to increased ozone and 3 to 4 days after exposure to increased particulate matter. For every 1 unit increase in the Air Quality Health Index, discharge diagnosis of OM increased 5% to 6% three days postexposure. Effects were stronger using the nonlinear time series analysis. The overall risk for OM, in the first 15 days after an increase in the Air Quality Health Index, was 1.22 times the risk of OM on days following no increase in exposures.
  
  
  CONCLUSIONS
  These findings confirm that there is an association between the multipollutant Air Quality Health Index and emergency department visits for OM. The findings can be used to inform risk communication, patient education, and policy.
  
  
  CONCLUSIONS
  Clinicians can use the Air Quality Health Index as an education and advocacy tool to promote and protect the health of those at high risk for OM to reduce exposures.
authors.affiliation: Assistant Professor, Department of Mathematics and Statistics, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Termeh
authors.initials: T
authors.lastname: Kousha
authors.affiliation: Assistant Professor, State University of New York at Buffalo, School of Nursing, Buffalo, NY, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Castner
mesh_terms: D000397:Air Pollution / Q000009:adverse effects* / Q000032:analysis; D016022:Case-Control Studies; D002675:Child, Preschool; D018592:Cross-Over Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004781:Environmental Exposure / Q000009:adverse effects* / Q000032:analysis; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009864:Ontario / Q000453:epidemiology; D010033:Otitis Media / Q000453:epidemiology / Q000628:therapy*; D010126:Ozone / Q000009:adverse effects / Q000032:analysis; D052638:Particulate Matter / Q000009:adverse effects / Q000032:analysis; D012189:Retrospective Studies
chemical_list: D052638:Particulate Matter; D010126:Ozone
keywords: Air Quality Health Index; Air pollution; children; emergency department; odds ratio; otitis media