Short-term effects of ambient air pollutants on asthma-related emergency department visits in Indianapolis, Indiana, 2007–2011

Abstract

Objective: We estimate the short-term associations between daily changes in ambient air pollutants and daily asthma-related emergency department (ED) visits in Indianapolis, IN. Methods: We identified asthma-related ED visits among Indianapolis residents aged ≥5 years. We used Poisson regression in a time-series framework to estimate the increased risk for asthma-related ED visits from exposure to ambient SO₂, PM_2.5 and ozone during the warm season (April–September) and SO₂ and PM_2.5 during the cold (October–March) season, from 2007 to 2011. Our models controlled for measured confounders, including weather and respiratory infections, as well as unmeasured confounders using a natural cubic spline to account for long-term seasonal trends. Results: During 2007–2011 in Indianapolis, 165 056 asthma-related ED visits occurred. We found statistically significant positive associations (p < 0.05) between ambient air pollutants and ED visits during the warm season for persons aged 5–44 years. Interquartile range increases in daily ozone concentrations with same day, 2-day lagged, and 3-day moving average were associated with increased risks for ED visits of 3.2% (95% CI: 0.2%, 6.3%), 4.4% (0.1%, 8.9%) and 4.8% (0.2%, 9.6%), respectively. Interquartile range increases in 3-day moving averages for SO₂ were associated with an increased risk of 3.3% (95% CI: 0.2%, 6.5%). We identified statistically significant associations (p < 0.05) between increased SO₂ and PM_2.5 levels and decreased ED visits among some age groups, primarily during the cold season, and no significant positive associations between changes in PM_2.5 concentration and asthma-related ED visits. Conclusions: During the warm season, increases in ozone and SO₂ concentrations were associated with increased asthma morbidity in children and young adults in Indianapolis. These results will enable reliable estimation of the health impacts of increases in these pollutants on asthma-related ED visits in Indianapolis and similar communities.

• Lagged effects
• ozone
• particulate matter
• sulfur dioxide
• time-series

Acknowledgements

We thank W. Dana Flanders of Emory University for guidance on the statistical model building for this study, Eric Bailey of the Indiana Department of Environmental Management for his assistance with programming the statistical models in R, and the Indiana Hospital Association for providing the emergency department data.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention, the Indiana Department of Environmental Management, or the Indiana State Department of Health.