title: Pediatric emergency department visits and ambient Air pollution in the U.S. State of Georgia: a case-crossover study.
abstract: BACKGROUND
  Estimating the health effects of ambient air pollutant mixtures is necessary to understand the risk of real-life air pollution exposures.
  
  
  METHODS
  Pediatric Emergency Department (ED) visit records for asthma or wheeze (n = 148,256), bronchitis (n = 84,597), pneumonia (n = 90,063), otitis media (n = 422,268) and upper respiratory tract infection (URI) (n = 744,942) were obtained from Georgia hospitals during 2002-2008. Spatially-contiguous daily concentrations of 11 ambient air pollutants were estimated from CMAQ model simulations that were fused with ground-based measurements. Using a case-crossover study design, odds ratios for 3-day moving average air pollutant concentrations were estimated using conditional logistic regression, matching on ZIP code, day-of-week, month, and year.
  
  
  RESULTS
  In multipollutant models, the association of highest magnitude observed for the asthma/wheeze outcome was with "oxidant gases" (O3, NO2, and SO2); the joint effect estimate for an IQR increase of this mixture was OR: 1.068 (95% CI: 1.040, 1.097). The group of "secondary pollutants" (O3and the PM2.5components SO42-, NO3-, and NH4+) was strongly associated with bronchitis (OR: 1.090, 95% CI: 1.050, 1.132), pneumonia (OR: 1.085, 95% CI: 1.047, 1.125), and otitis media (OR: 1.059, 95% CI: 1.042, 1.077). ED visits for URI were strongly associated with "oxidant gases," "secondary pollutants," and the "criteria pollutants" (O3, NO2, CO, SO2, and PM2.5).
  
  
  CONCLUSIONS
  Short-term exposures to air pollution mixtures were associated with ED visits for several different pediatric respiratory diseases.
authors.affiliation: Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Qingyang
authors.initials: Q
authors.lastname: Xiao
authors.affiliation: Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA, USA.
authors.forename: James A
authors.initials: JA
authors.lastname: Mulholland
authors.affiliation: Department of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA, USA.
authors.forename: Armistead G
authors.initials: AG
authors.lastname: Russell
authors.affiliation: School of Community Health Sciences, University of Nevada - Reno, 1664 N Virginia Street MS 0274, Reno, NV, 89557, USA.
authors.forename: Lyndsey A
authors.initials: LA
authors.lastname: Darrow
authors.affiliation: Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Paige E
authors.initials: PE
authors.lastname: Tolbert
authors.affiliation: School of Community Health Sciences, University of Nevada - Reno, 1664 N Virginia Street MS 0274, Reno, NV, 89557, USA. mstrickland@unr.edu.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Strickland
mesh_terms: D000293:Adolescent; D000393:Air Pollutants / Q000032:analysis; D000397:Air Pollution / Q000032:analysis*; D064751:Ammonium Compounds / Q000032:analysis; D002248:Carbon Monoxide / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D018592:Cross-Over Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004781:Environmental Exposure / Q000032:analysis; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009566:Nitrates / Q000032:analysis; D009585:Nitrogen Dioxide / Q000032:analysis; D016017:Odds Ratio; D010033:Otitis Media / Q000453:epidemiology*; D010126:Ozone / Q000032:analysis; D052638:Particulate Matter / Q000032:analysis; D012140:Respiratory Tract Diseases / Q000453:epidemiology*; D013431:Sulfates / Q000032:analysis; D013458:Sulfur Dioxide / Q000032:analysis
chemical_list: D000393:Air Pollutants; D064751:Ammonium Compounds; D009566:Nitrates; D052638:Particulate Matter; D013431:Sulfates; D013458:Sulfur Dioxide; D010126:Ozone; D002248:Carbon Monoxide; D009585:Nitrogen Dioxide
keywords: Air pollution; CMAQ; Multipollutant model; Pediatric Emergency Department Visits