Ambient air pollution is associated with pediatric pneumonia: a time-stratified case-crossover study in an urban area

• Published in: Environmental health Vol. 18; no. 1; p. 77
• Main Authors: Cheng, Chi-Yung, Cheng, Shih-Yu, Chen, Chien-Chih, Pan, Hsiu-Yung, Wu, Kuan-Han, Cheng, Fu-Jen
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 28-08-2019; BioMed Central; BMC
• Subjects: Adolescent; Air monitoring; Air Pollutants - adverse effects; Air pollution; Air Pollution - adverse effects; Air pollution effects; Air pollution measurements; Air pollution research; Air quality; Air quality assessments; Air quality measurements; Care and treatment; Child; Child, Preschool; Childhood; Childhood pneumonia; Children; Confidence intervals; Cross-Over Studies; Emergency medical services; Emergency Service, Hospital - statistics & numerical data; Environmental Exposure - adverse effects; Environmental hazards; Environmental health; Environmental monitoring; Exposure; Female; Health aspects; Hospital emergency services; Humans; Incidence; Infant; Infant, Newborn; Male; Medical records; Nitrogen dioxide; Nitrogen oxides; Particulate emissions; Particulate matter; Particulate Matter - adverse effects; Patient outcomes; Patients; Pediatric; Pediatrics; Pneumonia; Pneumonia - epidemiology; Pneumonia - etiology; Pollutants; Pollution; Pollution effects; Pollution monitoring; Risk factors; Season; Subgroups; Sulfur; Sulfur compounds; Sulfur dioxide; Taiwan - epidemiology; Trauma; Urban areas; Taiwan; Air pollution; Pneumonia; Season; Pediatric; Particulate matter
• ISSN: 1476-069X; 1476-069X
• DOI: 10.1186/s12940-019-0520-4

Pneumonia, the leading reason underlying childhood deaths, may be triggered or exacerbated by air pollution. To date, only a few studies have examined the association of air pollution with emergency department (ED) visits for pediatric pneumonia, with inconsistent results. Therefore, we aimed to elucidate the impact of short-term exposure to particulate matter (PM) and other air pollutants on the incidence of ED visits for pediatric pneumonia.
PM
, PM
, and other air pollutant levels were measured at 11 air quality-monitoring stations in Kaohsiung City, Taiwan, between 2008 and 2014. Further, we extracted the medical records of non-trauma patients aged ≤17 years and who had visited an ED with the principal diagnosis of pneumonia. A time-stratified case-crossover study design was employed to determine the hazard effect of air pollution in a total of 4024 patients.
The single-pollutant model suggested that per interquartile range increment in PM
, PM
, nitrogen dioxide (NO
), and sulfur dioxide (SO
) on 3 days before the event increased the odds of pediatric pneumonia by 14.0% [95% confidence interval (CI), 5.1-23.8%], 10.9% (95% CI, 2.4-20.0%), 14.1% (95% CI, 5.0-24.1%), and 4.5% (95% CI, 0.8-8.4%), respectively. In two-pollutant models, PM
and NO
were significant after adjusting for PM
and SO
. Subgroup analyses showed that older children (aged ≥4 years) were more susceptible to PM
(interaction p = 0.024) and children were more susceptible to NO
during warm days (≥26.5 °C, interaction p = 0.011).
Short-term exposure to PM
and NO
possibly plays an important role in pediatric pneumonia in Kaohsiung, Taiwan. Older children are more susceptible to PM
, and all children are more susceptible to NO
during warm days.