title: Association between chronic exposure to air pollution and mortality in the acute respiratory distress syndrome.
abstract: The impact of chronic exposure to air pollution and outcomes in the acute respiratory distress syndrome (ARDS) is unknown. The Nationwide Inpatient Sample (NIS) from 2011 was utilized for this analysis. The NIS is a national database that captures 20% of all US in-patient hospitalizations from 47 states. Patients with ARDS who underwent mechanical ventilation from the highest 15 ozone pollution cities were compared with the rest of the country. Secondary analyses assessed outcomes of ARDS patients for ozone pollution and particulate matter pollution on a continuous scale by county of residence. A total of 8,023,590 hospital admissions from the 2011 NIS sample were analyzed. There were 93,950 patients who underwent mechanical ventilation for ARDS included in the study. Patients treated in high ozone regions had significantly higher unadjusted hospital mortality (34.9% versus 30.8%, p < 0.01) than patients in cities with control levels of ozone. After controlling for all variables in the model, treatment in a hospital located in a high ozone pollution area was associated with an increased odds of in-hospital mortality (OR 1.11, 95% CI 1.08-1.15, p < 0.01). After adjustment for all variables in the model, for each increase in ozone exposure by 0.01 ppm the OR for death was 1.07 (95% CI 1.06-1.08, p < 0.01). Similarly, for each increase in particulate matter exposure by 10 μg/m3, the OR for death was 1.08 (95% CI 1.02-1.16, p < 0.01). Chronic exposure to both ozone and particulate matter pollution is associated with higher rates of mortality in ARDS. These preliminary findings need to be confirmed by further detailed studies.
authors.affiliation: Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Ave, Boston, MA 02115, USA; Centre for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, Canada. Electronic address: bar890@mail.harvard.edu.
authors.forename: Barret
authors.initials: B
authors.lastname: Rush
authors.affiliation: Department of Critical Care Medicine, Surrey Memorial Hospital, Surrey, BC, Canada. Electronic address: robmcdermid@telus.net.
authors.forename: Robert C
authors.initials: RC
authors.lastname: McDermid
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, MA, USA. Electronic address: lceli@bidmc.harvard.edu.
authors.forename: Leo Anthony
authors.initials: LA
authors.lastname: Celi
authors.affiliation: Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Centre for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, Canada. Electronic address: Keith.Walley@hli.ubc.ca.
authors.forename: Keith R
authors.initials: KR
authors.lastname: Walley
authors.affiliation: Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Centre for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, Canada. Electronic address: Jim.Russell@hli.ubc.ca.
authors.forename: James A
authors.initials: JA
authors.lastname: Russell
authors.affiliation: Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Centre for Heart Lung Innovation (HLI), University of British Columbia, Vancouver, Canada. Electronic address: John.Boyd@hli.ubc.ca.
authors.forename: John H
authors.initials: JH
authors.lastname: Boyd
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000393:Air Pollutants / Q000009:adverse effects* / Q000032:analysis*; D000397:Air Pollution / Q000009:adverse effects*; D002947:Cities; D004781:Environmental Exposure / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D010126:Ozone / Q000009:adverse effects* / Q000032:analysis; D052638:Particulate Matter / Q000009:adverse effects / Q000032:analysis*; D012128:Respiratory Distress Syndrome / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality*; D014481:United States / Q000453:epidemiology
chemical_list: D000393:Air Pollutants; D052638:Particulate Matter; D010126:Ozone