Effect of Ambient Air Pollution on Hospital Readmissions among the Pediatric Asthma Patient Population in South Texas: A Case-Crossover Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Sources and Study Setting
2.2. Study Design and Measurement
2.3. Statistical Analysis
3. Results
4. Discussion
4.1. Limitations
4.2. Health Policy and Practice Implications
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Appendix A
Variable | PM2.5 | Ozone | Temperature |
---|---|---|---|
PM2.5 | 1.00 | ||
Ozone | −0.214 * | 1.00 | |
Temperature | −0.216 * | 0.077 | 1.00 |
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Variable | Mean ± SD [Min, Max] or N (%) |
---|---|
Age (years) | 9.54 ± 3.34 [5, 18] |
Age | |
5–11 years old | 88 (79.3) |
12–18 years old | 23 (20.7) |
Gender | |
Female | 47 (42.3) |
Male | 64 (57.6) |
Ethnicity | |
Hispanic | 88 (79.3) |
Non-Hispanic | 23 (20.7) |
Type of insurance | |
Public (Medicaid) | 78 (70.3) |
Private | 29 (26.1) |
Self-pay | 4 (3.6) |
Days to readmission (days) | 386.5 ± 364.24 [1, 1651] |
1–30 days | 9 (8.1) |
31–90 days | 12 (10.8) |
91–180 days | 19 (17.1) |
181–365 days | 30 (27.1) |
366 days or longer | 41 (36.9) |
Season | |
Warm (May–October) | 53 (47.7) |
Cold (November–April) | 58 (52.3) |
Year | |
2010 | 13 (11.7) |
2011 | 22 (19.8) |
2012 | 18 (16.2) |
2013 | 26 (23.4) |
2014 | 32 (28.8) |
Variable | Mean | SD | Minimum | Percentile | Maximum | IQR | ||
---|---|---|---|---|---|---|---|---|
25 | 50 | 75 | ||||||
PM2.5 (μg/m3) | 8.30 | 1.49 | 4.66 | 7.19 | 8.25 | 9.19 | 12.37 | 2.0 |
Ozone (ppb) | 37.37 | 6.81 | 20.53 | 31.47 | 37.24 | 42.11 | 52.84 | 10.64 |
Temperature (°C) | 20.20 | 5.85 | 8.83 | 16.31 | 21.01 | 26.91 | 29.73 | 10.6 |
Single- and Cumulative-Day Lags | Single-Pollutant Model | Two-Pollutant Model | ||||||
---|---|---|---|---|---|---|---|---|
PM2.5 | Ozone | PM2.5 | Ozone | |||||
OR (95% CI) | p-Value | OR (95% CI) | p-Value | OR (95% CI) | p-Value | OR (95% CI) | p-Value | |
Lag0 | 0.972 (0.897–1.052) | 0.479 | 1.020 (0.999–1.041) | 0.064 | 0.954 (0.878–1.037) | 0.272 | 1.023 (1.001–1.045) | 0.042 * |
Lag1 | 1.082 (1.008–1.162) | 0.030 * | 1.008 (0.987–1.028) | 0.469 | 1.080 (1.005–1.161) | 0.036 * | 1.005 (0.984–1.025) | 0.665 |
Lag2 | 0.984 (0.914–1.059) | 0.664 | 1.001 (0.979–1.022) | 0.955 | 0.983 (0.912–1.059) | 0.655 | 1.001 (0.980–1.023) | 0.904 |
Lag3 | 0.985 (0.914–1.063) | 0.700 | 1.007 (0.988–1.027) | 0.472 | 0.980 (0.907–1.059) | 0.613 | 1.008 (0.988–1.028) | 0.429 |
Lag0–1 | 1.046 (0.954–1.147) | 0.334 | 1.016 (0.993–1.039) | 0.168 | 1.036 (0.942–1.138) | 0.468 | 1.014 (0.992–1.037) | 0.222 |
Lag0–2 | 1.032 (0.929–1.145) | 0.558 | 1.013 (0.989–1.038) | 0.292 | 1.023 (0.921–1.138) | 0.667 | 1.012 (0.988–1.037) | 0.667 |
Lag0–3 | 1.017 (0.907–1.140) | 0.779 | 1.015 (0.988–1.042) | 0.275 | 1.006 (0.896–1.131) | 0.915 | 1.015 (0.988–1.042) | 0.290 |
Single- and Cumulative-Day Lags | 5–11 Years Old | 12–18 Years Old | ||||||
---|---|---|---|---|---|---|---|---|
Single-Pollutant | Two-Pollutant | Single-Pollutant | Two-Pollutant | |||||
PM2.5 | Ozone | PM2.5 | Ozone | PM2.5 | Ozone | PM2.5 | Ozone | |
Lag0 | 0.934 (0.850–1.026) | 1.022 (0.999–1.047) | 0.908 (0.821–1.004) | 1.029* (1.004–1.055) | 1.123 (0.942–1.337) | 1.009 (0.964–1.057) | 1.122 (0.942–1.336) | 1.008 (0.965–1.054) |
Lag1 | 1.075 (0.994–1.162) | 1.009 (0.986–1.033) | 1.071 (0.990–1.159) | 1.006 (0.982–1.030) | 1.112 (0.924–1.338) | 1.001 (0.959–1.046) | 1.113 (0.924–1.339) | 1.002 (0.960–1.045) |
Lag2 | 0.962 (0.881–1.050) | 1.003 (0.980–1.027) | 0.959 (0.878–1.048) | 1.005 (0.981–1.029) | 1.045 (0.908–1.204) | 0.983 (0.933–1.034) | 1.062 (0.917–1.230) | 0.978 (0.927–1.031) |
Lag3 | 0.983 (0.905–1.067) | 1.004 (0.982–1.026) | 0.980 (0.902–1.066) | 1.005 (0.983–1.027) | 0.969 (0.795–1.182) | 1.016 (0.968–1.067) | 0.953 (0.779–1.166) | 1.019 (0.969–1.071) |
Lag0–1 | 1.017 (0.917–1.127) | 1.018 (0.993–1.044) | 1.000 (0.899–1.112) | 1.018 (0.992–1.045) | 1.174 (0.945–1.459) | 1.006 (0.958–1.056) | 1.176 (0.946–1.462) | 1.007 (0.960–1.055) |
Lag0–2 | 0.994 (0.880–1.122) | 1.016 (0.989–1.044) | 0.982 (0.868–1.111) | 1.017 (0.989–1.045) | 1.152 (0.923–1.437) | 1.000 (0.948–1.056) | 1.153 (0.923–1.440) | 0.997 (0.946–1.051) |
Lag0–3 | 0.983 (0.861–1.121) | 1.016 (0.987–1.047) | 0.970 (0.848–1.110) | 1.017 (0.987–1.048) | 1.123 (0.879–1.435) | 1.006 (0.948–1.067) | 1.122 (0.877–1.435) | 1.003 (0.946–1.063) |
Single- and Cumulative-Day Lags | Girls | Boys | ||||||
---|---|---|---|---|---|---|---|---|
Single-Pollutant | Two-Pollutant | Single-Pollutant | Two-Pollutant | |||||
PM2.5 | Ozone | PM2.5 | Ozone | PM2.5 | Ozone | PM2.5 | Ozone | |
Lag0 | 0.936 (0.819–1.070) | 1.021 (0.989–1.054) | 0.902 (0.776–1.048) | 1.029 (0.993–1.066) | 0.994 (0.900–1.099) | 1.019 (0.991–1.047) | 0.983 (0.888–1.089) | 1.019 (0.991–1.048) |
Lag1 | 1.113 (0.997–1.244) | 1.012 (0.984–1.042) | 1.108 (0.989–1.240) | 1.007 (0.977–1.037) | 1.061 (0.965–1.166) | 1.002 (0.973–1.032) | 1.061 (0.965–1.166) | 1.001 (0.972–1.031) |
Lag2 | 0.972 (0.858–1.102) | 1.003 (0.973–1.035) | 0.967 (0.849–1.101) | 1.006 (0.974–1.038) | 0.986 (0.900–1.079) | 0.996 (0.967–1.027) | 0.986 (0.900–1.080) | 0.996 (0.967–1.027) |
Lag3 | 0.984 (0.875–1.107) | 1.007 (0.979–1.037) | 0.972 (0.858–1.100) | 1.010 (0.980–1.041) | 0.985 (0.892–1.087) | 1.005 (0.979–1.033) | 0.984 (0.891–1.087) | 1.006 (0.979–1.033) |
Lag0–1 | 1.053 (0.911–1.218) | 1.018 (0.986–1.052) | 1.032 (0.885–1.203) | 1.016 (0.983–1.051) | 1.044 (0.926–1.175) | 1.012 (0.982–1.044) | 1.038 (0.921–1.171) | 1.011 (0.980–1.043) |
Lag0–2 | 1.038 (0.882–1.222) | 1.016 (0.981–1.052) | 1.019 (0.859–1.208) | 1.015 (0.979–1.052) | 1.026 (0.897–1.175) | 1.009 (0.974–1.044) | 1.025 (0.895–1.173) | 1.008 (0.974–1.044) |
Lag0–3 | 1.015 (0.852–1.209) | 1.016 (0.979–1.054) | 0.989 (0.821–1.193) | 1.017 (0.978–1.057) | 1.013 (0.872–1.176) | 1.011 (0.973–1.050) | 1.012 (0.871–1.176) | 1.011 (0.973–1.050) |
Single- and Cumulative-Day Lags | Warm Season (May–October) | Cold Season (November–April) | ||||||
---|---|---|---|---|---|---|---|---|
Single-Pollutant | Two-Pollutant | Single-Pollutant | Two-Pollutant | |||||
PM2.5 | Ozone | PM2.5 | Ozone | PM2.5 | Ozone | PM2.5 | Ozone | |
Lag0 | 1.056 (0.941–1.184) | 1.043 ** (1.012–1.075) | 0.993 (0.874–1.127) | 1.043 * (1.010–1.078) | 0.920 (0.818–1.034) | 1.023 (0.986–1.062) | 0.922 (0.818–1.038) | 1.022 (0.985–1.061) |
Lag1 | 1.134 * (1.019–1.262) | 1.016 (0.989–1.043) | 1.125 * (1.009–1.254) | 1.009 (0.982–1.037) | 1.032 (0.933–1.141) | 1.013 (0.975–1.053) | 1.030 (0.931–1.138) | 1.013 (0.975–1.052) |
Lag2 | 1.038 (0.933–1.155) | 1.003 (0.976–1.031) | 1.037 (0.930–1.158) | 1.001 (0.973–1.030) | 0.934 (0.837–1.042) | 1.008 (0.970–1.047) | 0.932 (0.835–1.041) | 1.009 (0.970–1.050) |
Lag3 | 1.011 (0.915–1.116) | 1.013 (0.989–1.039) | 0.995 (0.895–1.106) | 1.014 (0.988–1.041) | 0.956 (0.853–1.071) | 1.011 (0.973–1.051) | 0.956 (0.853–1.071) | 1.011 (0.972–1.052) |
Lag0–1 | 1.146 * (1.003–1.309) | 1.033 * (1.002–1.065) | 1.105 (0.961–1.271) | 1.025 (0.993–1.059) | 0.965 (0.844–1.104) | 1.023 (0.982–1.066) | 0.968 (0.846–1.108) | 1.022 (0.981–1.066) |
Lag0–2 | 1.151 (0.989–1.340) | 1.026 (0.994–1.060) | 1.123 (0.960–1.314) | 1.020 (0.987–1.054) | 0.926 (0.793–1.081) | 1.023 (0.977–1.071) | 0.927 (0.795–1.082) | 1.023 (0.977–1.072) |
Lag0–3 | 1.132 (0.965–1.329) | 1.031 (0.997–1.066) | 1.098 (0.929–1.296) | 1.025 (0.990–1.062) | 0.892 (0.744–1.070) | 1.029 (0.976–1.085) | 0.894 (0.747–1.070) | 1.029 (0.975–1.087) |
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Baek, J.; Kash, B.A.; Xu, X.; Benden, M.; Roberts, J.; Carrillo, G. Effect of Ambient Air Pollution on Hospital Readmissions among the Pediatric Asthma Patient Population in South Texas: A Case-Crossover Study. Int. J. Environ. Res. Public Health 2020, 17, 4846. https://doi.org/10.3390/ijerph17134846
Baek J, Kash BA, Xu X, Benden M, Roberts J, Carrillo G. Effect of Ambient Air Pollution on Hospital Readmissions among the Pediatric Asthma Patient Population in South Texas: A Case-Crossover Study. International Journal of Environmental Research and Public Health. 2020; 17(13):4846. https://doi.org/10.3390/ijerph17134846
Chicago/Turabian StyleBaek, Juha, Bita A. Kash, Xiaohui Xu, Mark Benden, Jon Roberts, and Genny Carrillo. 2020. "Effect of Ambient Air Pollution on Hospital Readmissions among the Pediatric Asthma Patient Population in South Texas: A Case-Crossover Study" International Journal of Environmental Research and Public Health 17, no. 13: 4846. https://doi.org/10.3390/ijerph17134846