title: Seven-day cumulative effects of air pollutants increase respiratory ER visits up to threefold.
abstract: Children are especially vulnerable to respiratory injury induced by exposure to air pollutants. In the present study, we investigate periods of up to 7 days, and evaluate the lagged effects of exposure to air pollutants on the daily number of children and adolescents visiting the emergency room (ER) for the treatment of lower respiratory obstructive diseases (LROD), in the city of São Paulo, Brazil.
  
  
  
  Daily records of LROD-related ER visits by children and adolescents under the age of 19, from January 2000 to December 2007 (2,922 days) were included in the study. Time-series regression models (generalized linear Poisson) were used to control for short- and long-term trends, as well as for temperature and relative humidity. Third-degree polynomial lag models were used to estimate both lag structures and the cumulative effects of air pollutants. Effects of air pollutants were expressed as the percentage increase in LROD-related ER visits.
  
  
  
  We observed an acute effect at the same day of exposure to air pollutants; however, the cumulative effects of air pollutants on the number of LROD-related ER visits was almost threefold greater than the one observed at the same day of exposure to PM10, SO2, and NO2mainly in children aged 5 years and under. The 7-day cumulative effect of SO2reached 11.0% (95% CI: 5.0-16.7) increase in visits. Conclusion and Relevance: This study highlights the effects of intermediate-term exposure to air pollutants on LROD in children. Pediatr Pulmonol. 2017;52:205-212. © 2016 Wiley Periodicals, Inc.
authors: Emergency Department, Children's Institute, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.
authors: Cláudio
authors: C
authors: Schvartsman
authors: Environmental Epidemiology Study Group, Laboratory of Experimental Air Pollution, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil.|Environmental Exposure and Risk Assessment Group, Collective Health Post-Graduation Program, Universidade Catolica de Santos, Sao Paulo, Brazil.
authors: Luiz Alberto Amador
authors: LA
authors: Pereira
authors: Environmental Epidemiology Study Group, Laboratory of Experimental Air Pollution, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil.|Environmental Exposure and Risk Assessment Group, Collective Health Post-Graduation Program, Universidade Catolica de Santos, Sao Paulo, Brazil.
authors: Alfésio Luiz Ferreira
authors: AL
authors: Braga
authors: Emergency Department, Children's Institute, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.|Environmental Epidemiology Study Group, Laboratory of Experimental Air Pollution, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil.
authors: Sylvia Costa Lima
authors: SC
authors: Farhat
mesh_terms: D000293:Adolescent; D000393:Air Pollutants / Q000032:analysis*; D000397:Air Pollution / Q000706:statistics & numerical data*; D001249:Asthma / Q000453:epidemiology*; D001938:Brazil / Q000453:epidemiology; D001988:Bronchiolitis / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D006813:Humidity; D007223:Infant; D007231:Infant, Newborn; D008171:Lung Diseases / Q000453:epidemiology; D008297:Male; D015233:Models, Statistical; D013696:Temperature
chemical_list: D000393:Air Pollutants
keywords: ER visit; air pollutants; children; cumulative effect; lower respiratory obstructive diseases