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Tracking Associations Between Ambient Ozone and Asthma-Related Emergency Department Visits Using Case-Crossover Analysis

Paulu, Chris ScD; Smith, Andy E. ScD

Journal of Public Health Management and Practice: November-December 2008 - Volume 14 - Issue 6 - p 581–591
doi: 10.1097/01.PHH.0000338371.53242.0e
Science and Data

Traditional environmental public health surveillance consists of separately measuring hazards, exposures, and health outcomes. The Environmental Public Health Tracking (EPHT) Network seeks to accrue additional information by linking hazard or exposure data to health outcomes data. A natural progression is to consider tracking the “link” itself, that is, to track the association between an environmental hazard and a health outcome. The Maine EPHT Program conducted a case-crossover analysis to measure associations between daily estimated ambient ozone and particulate matter (PM2.5) and asthma-related emergency department (ED) visits for 2000–2003. We found an overall association of 7 percent (95% confidence interval, 4–11) excess asthma-related ED visits per 10-ppb increase in ozone averaged over 4 days (lag 0–3). The association was positive in the first 3 years and negative in the last. The excess risk was concentrated among females aged 15 to 34 and males younger than 15. The methodology for tracking associations between ambient air quality and acute morbidity is not generalizable to most other EPHT topic areas, but there are ample reasons to pursue this activity. The analysis can potentially help evaluate the effectiveness of regulatory and intervention programs, as well as inform us about trends, sensitive subpopulations, and changing potency of air constituents.

This study tracks associations between ambient ozone and asthma-related emergency department visits using case-crossover analysis.

Chris Paulu, ScD, is an Assistant Research Professor of Epidemiology, Department of Applied Medical Sciences, University of Southern Maine, Portland, State of Maine.

Andy E. Smith, ScD, is the State Toxicologist and Director of the Environmental and Occupational Health Programs, Maine Center for Disease Control and Prevention, Department of Health and Human Services, State of Maine.

Corresponding Author: Chris Paulu, ScD, Environmental and Occupational Health Programs, Maine Center for Disease Control and Prevention, 286 Water St, 11 State House Station, Augusta, ME 04333.

This research was supported by cooperative agreement (U50/CCU122452) from the Centers for Disease Control and Prevention. The authors thank EPA ORD and OAQPS staff, Amy Nail, Fred Dimmick, and Ellen Baldridge, for generating the ambient air datasets and providing appropriate background information; Tom Bateson for training in case-crossover analysis; Valerie Haley of New York State Department of Health for valuable discussions and insight; the Public Health Air Surveillance Evaluation workgroup for promoting multidisciplinary knowledge sharing; and Martha E. Webster of the Maine Department of Environmental Protection for additional insight into meteorology and ambient air monitoring.

© 2008 Lippincott Williams & Wilkins, Inc.