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The Effects of Ambient Air Pollution on School Absenteeism Due to Respiratory Illnesses

Gilliland, Frank D.1; Berhane, Kiros1; Rappaport, Edward B.1; Thomas, Duncan C.1; Avol, Edward1; Gauderman, W. James1; London, Stephanie J.2; Margolis, Helene G.3; McConnell, Rob1; Islam, K. Talat1; Peters, John M.1

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We investigated the relations between ozone (O3), nitrogen dioxide (NO2), and respirable particles less than 10 μm in diameter (PM10) and school absenteeism in a cohort of 4th-grade school children who resided in 12 southern California communities. An active surveillance system ascertained the numbers and types of absences during the first 6 months of 1996. Pollutants were measured hourly at central-site monitors in each of the 12 communities. To examine acute effects of air pollution on absence rates, we fitted a two-stage time-series model to the absence count data that included distributed lag effects of exposure adjusted for long-term pollutant levels. Short-term change in O3, but not NO2 or PM10, was associated with a substantial increase in school absences from both upper and lower respiratory illness. An increase of 20 ppb of O3 was associated with an increase of 62.9% [95% confidence interval (95% CI) = 18.4–124.1%] for illness-related absence rates, 82.9% (95% CI = 3.9–222.0%) for respiratory illnesses, 45.1% (95% CI = 21.3–73.7%) for upper respiratory illnesses, and 173.9% (95% CI = 91.3–292.3%) for lower respiratory illnesses with wet cough. The short-term effects of a 20-ppb change of O3 on illness-related absenteeism were larger in communities with lower long-term average PM10 [223.5% (95% CI = 90.4–449.7)] compared with communities with high average levels [38.1% (95% CI = 8.5–75.8)]. Increased school absenteeism from O3 exposure in children is an important adverse effect of ambient air pollution worthy of public policy consideration.

© 2001 Lippincott Williams & Wilkins, Inc.

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