A time-stratified case-crossover study of ambient ozone exposure and emergency department visits for specific respiratory diagnoses in California (2005-2008)

Malig, Brian J.; Pearson, Dharshani L.; Chang, Yun Brenda; Broadwin, Rachel; Basu, Rupa; Green, Rochelle S.; Ostro, Bart

doi:10.1289/ehp.1409495

Cited by 103Air Quality and Health ImpactsIndoor Air Quality and Microbial ExposureClimate Change and Health Impacts

A time-stratified case-crossover study of ambient ozone exposure and emergency department visits for specific respiratory diagnoses in California (2005-2008)

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Malig, Brian J., Pearson, Dharshani L., Chang, Yun Brenda, Broadwin, Rachel, Basu, Rupa, Green, Rochelle S., Ostro, Bart·2016·Environmental Health Perspectives

DOI 10.1289/ehp.1409495PMC PMC4892911

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Abstract

BACKGROUND: Studies have explored ozone's connection to asthma and total respiratory emergency department visits (EDVs) but have neglected other specific respiratory diagnoses despite hypotheses relating ozone to respiratory infections and allergic responses. OBJECTIVE: We examined relationships between ozone and EDVs for respiratory visits, including specifically acute respiratory infections (ARI), asthma, pneumonia, chronic obstructive pulmonary disease (COPD), and upper respiratory tract inflammation (URTI). METHODS: We conducted a multi-site time-stratified case-crossover study of ozone exposures for approximately 3.7 million respiratory EDVs from 2005 through 2008 among California residents living within 20 km of an ozone monitor. Conditional logistic regression was used to estimate associations by climate zone. Random effects meta-analysis was then applied to estimate pooled excess risks (ER). Effect modification by season, distance from the monitor and individual demographic characteristics (i.e., age, race/ethnicity, sex, and payment method), and confounding by other gaseous air pollutants were also investigated. Meta-regression was utilized to explore how climate zone-level meteorological, demographic, and regional differences influenced estimates. RESULTS: We observed ozone-associated increases in all respiratory, asthma, and ARI visits, which were slightly larger in the warm season [asthma ER per 10-ppb increase in mean of same and previous 3 days ozone exposure (lag03) = 2.7%, 95% CI: 1.5, 3.9; ARI ERlag03 = 1.4%, 95% CI: 0.8, 1.9]. EDVs for pneumonia, COPD, and URTI were also significantly associated with ozone exposure over the whole year, but typically more consistently so during the warm season. CONCLUSIONS: Short-term ozone exposures among California residents living near an ozone monitor were positively associated with EDVs for asthma, ARI, pneumonia, COPD, and URTI from 2005 through 2008. Those associations were typically larger and more consistent during the warm season. Our findings suggest that these outcomes should be considered when evaluating the potential health benefits of reducing ozone concentrations. CITATION: Malig BJ, Pearson DL, Chang YB, Broadwin R, Basu R, Green RS, Ostro B. 2016. A time-stratified case-crossover study of ambient ozone exposure and emergency department visits for specific respiratory diagnoses in California (2005-2008). Environ Health Perspect 124:745-753; http://dx.doi.org/10.1289/ehp.1409495.

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On high ozone days, there have been increased school absences, increased visits to emergency rooms, and increased hospital admissions.
“On high ozone days, there have been increased school absences, increased visits to emergency rooms, and increased hospital admissions (27–30).”
From Ozone pollution: A Major health hazard worldwide (2019) · cites this paper as [29]

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Authors: Malig, B. J., Pearson, D. L., Chang, Y. B., Broadwin, R., Basu, R., Green, R. S., & Ostro, B.
Affiliations: Air and Climate Epidemiology Section, California Office of Environmental Health Hazard Assessment, Oakland, California, USA
University of California, Berkeley (US)
Corresponding author: Malig, Brian J.
ORCID: Malig, Brian J.
Pearson, Dharshani L.
Broadwin, Rachel
Basu, Rupa
Ostro, Bart
Venue: Environmental Health Perspectives
Publisher: American Chemical Society (ACS)
Published: 2015-12-08
Volume: 124
Issue: 6
Pages: 745-753
ISSN: 0091-6765 (ISSN-L)
1552-9924
DOI: 10.1289/ehp.1409495
PMC: PMC4892911
OpenAlex: W2444250501
Cited by: 103
References: 47
Citations by year: 2026: 2 · 2025: 13 · 2024: 12 · 2023: 9 · 2022: 8 · 2021: 10 · 2020: 18 · 2019: 9 · 2018: 10 · 2017: 9 · 2016: 3
FWCI: 4.59
Type: journal article
Language: en
Open access: gold
doi.org
Licence: public-domain
creativecommons.org/licenses/by/4.0/ (vor, 752 d)
Locations: Environmental Health Perspectives (publishedVersion, public-domain)
PubMed Central (publishedVersion, public-domain)
PubMed (publishedVersion)
Topics: Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Air Quality and Health Impacts
Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Indoor Air Quality and Microbial Exposure
Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Climate Change and Health Impacts
Keywords: ambient ozone, air pollution health effects, asthma, acute respiratory infections, pneumonia, chronic obstructive pulmonary disease, upper respiratory tract infection, seasonal variation, California residents
MeSH terms: Air Pollution, California, Emergency Service, Hospital, Environmental Exposure, Hospitalization, Humans, Ozone, Respiratory Tract Diseases

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A time-stratified case-crossover study of ambient ozone exposure and emergency department visits for specific respiratory diagnoses in California (2005-2008)

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