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Health risk of air pollution on people living with major chronic diseases: a Canadian population-based study
  1. Teresa To1,2,3,
  2. Laura Feldman1,2,
  3. Jacqueline Simatovic1,
  4. Andrea S Gershon1,2,3,4,
  5. Sharon Dell1,2,
  6. Jiandong Su3,
  7. Richard Foty1,2,
  8. Christopher Licskai5,6
  1. 1Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
  2. 2University of Toronto, Toronto, Ontario, Canada
  3. 3Institute for Clinical Evaluative Sciences, North York, Ontario, Canada
  4. 4Sunnybrook Health Sciences Centre, North York, Ontario, Canada
  5. 5Western University, London, Ontario, Canada
  6. 6St. Joseph's Health Care, London, Ontario, Canada
  1. Correspondence to Dr Teresa To; teresa.to{at}sickkids.ca

Abstract

Objectives The objective of this study was to use health administrative and environmental data to quantify the effects of ambient air pollution on health service use among those with chronic diseases. We hypothesised that health service use would be higher among those with more exposure to air pollution as measured by the Air Quality Health Index (AQHI).

Setting Health administrative data was used to quantify health service use at the primary (physician office visits) and secondary (emergency department visits, hospitalisations) level of care in Ontario, Canada.

Participants We included individuals who resided in Ontario, Canada, from 2003 to 2010, who were ever diagnosed with one of 11 major chronic diseases.

Outcome measures Rate ratios (RR) from Poisson regression models were used to estimate the short-term impact of incremental unit increases in AQHI, nitrogen dioxide (NO2; 10 ppb), fine particulate matter (PM2.5; 10 µg/m3) and ozone (O3; 10 ppb) on health services use among individuals with each disease. We adjusted for age, sex, day of the week, temperature, season, year, socioeconomic status and region of residence.

Results Increases in outpatient visits ranged from 1% to 5% for every unit increase in the 10-point AQHI scale, corresponding to an increase of about 15 000 outpatient visits on a day with poor versus good air quality. The greatest increases in outpatient visits were for individuals with non-lung cancers (AQHI:RR=1.05; NO2:RR=1.14; p<0.0001) and COPD (AQHI:RR=1.05; NO2:RR=1.12; p<0.0001) and in hospitalisations, for individuals with diabetes (AQHI:RR=1.04; NO2:RR=1.07; p<0.0001) and COPD (AQHI:RR=1.03; NO2:RR=1.09; p<1.001). The impact remained 2 days after peak AQHI levels.

Conclusions Among individuals with chronic diseases, health service use increased with higher levels of exposure to air pollution, as measured by the AQHI. Future research would do well to measure the utility of targeted air quality advisories based on the AQHI to reduce associated health service use.

  • PREVENTIVE MEDICINE
  • PUBLIC HEALTH

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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