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      Comparison of the Effects of Air Pollution on Outpatient and Inpatient Visits for Asthma: A Population-Based Study in Taiwan

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          Abstract

          Background

          A nationwide asthma survey on the effects of air pollution is lacking in Taiwan. The purpose of this study was to evaluate the time trend and the relationship between air pollution and health care services for asthma in Taiwan.

          Methods

          Health care services for asthma and ambient air pollution data were obtained from the National Health Insurance Research database and Environmental Protection Administration from 2000 through 2009, respectively. Health care services, including those related to the outpatient and inpatient visits were compared according to the concentration of air pollutants.

          Results

          The number of asthma-patient visits to health-care facilities continue to increase in Taiwan. Relative to the respective lowest quartile of air pollutants, the adjusted relative risks (RRs) of the outpatient visits in the highest quartile were 1.10 (P-trend  = 0.013) for carbon monoxide (CO), 1.10 (P-trend  = 0.015) for nitrogen dioxide (NO 2), and 1.20 (P-trend <0.0001) for particulate matter with an aerodynamic diameter ≦10µm (PM 10) in the child group (aged 0–18). For adults aged 19–44, the RRs of outpatient visits were 1.13 (P-trend = 0.078) for CO, 1.17 (P-trend = 0.002) for NO 2, and 1.13 (P-trend <0.0001) for PM 10. For adults aged 45–64, the RRs of outpatient visits were 1.15 (P-trend = 0.003) for CO, 1.19 (P-trend = 0.0002) for NO 2, and 1.10 (P-trend = 0.001) for PM 10. For the elderly (aged≥ 65), the RRs of outpatient visits in were 1.12 (P-trend  = 0.003) for NO 2 and 1.10 (P-trend  = 0.006) for PM 10. For inpatient visits, the RRs across quartiles of CO level were 1.00, 1.70, 1.92, and 1.86 (P-trend  = 0.0001) in the child group. There were no significant linear associations between inpatient visits and air pollutants in other groups.

          Conclusions

          There were positive associations between CO levels and childhood inpatient visits as well as NO 2, CO and PM 10 and outpatient visits.

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          Most cited references38

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          Motor vehicle air pollution and asthma in children: a meta-analysis.

          Janvier Gasana, Deepa Dillikar, Angelico Mendy … (2012)
          Asthma affects more than 17 million people in the United States;1/3 of these are children. Children are particularly vulnerable to airborne pollution because of their narrower airways and because they generally breathe more air per pound of body weight than adults, increasing their exposure to air pollutants. However, the results from previous studies on the association between motor vehicle emissions and the development of childhood wheeze and asthma are conflicting. Therefore, we conducted a meta-analysis to clarify their potential relationship. MEDLINE, Highwire, and The Cochrane Library databases were searched for relevant studies. Adjusted odds ratio (OR) with corresponding 95% confidence interval (CI) for the association between traffic air pollutants and wheeze or asthma were retrieved from individual studies and pooled to generate summary effect estimates (meta-OR) in STATA 11.1. Nineteen studies were included in the meta-analysis. Exposure to nitrogen dioxide (meta-OR: 1.05, 95% CI: 1.00-1.11), nitrous oxide (meta-OR: 1.02, 95% CI: 1.00-1.04), and carbon monoxide (meta-OR: 1.06, 95% CI: 1.01-1.12) were positively associated with a higher prevalence of childhood asthma. Exposure to sulfur dioxide (meta-OR: 1.04, 95% CI: 1.01-1.07) was positively associated with a higher prevalence of wheeze in children. Exposure to nitrogen dioxide was positively associated with a higher incidence of childhood asthma (meta-OR: 1.14, 95% CI: 1.06-1.24), and exposures to particulate matter was positively associated with a higher incidence of wheeze in children (meta-OR: 1.05, 95% CI: 1.04-1.07). Living or attending schools near high traffic density roads exposes children to higher levels of motor vehicle air pollutants, and increases the incidence and prevalence of childhood asthma and wheeze. Copyright © 2012 Elsevier Inc. All rights reserved.
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            The role of air pollution in asthma and other pediatric morbidities.

            George Thurston, Leonardo Trasande (2005)
            A growing body of research supports the role of outdoor air pollutants in acutely aggravating chronic diseases in children, and suggests that the pollutants may have a role in the development of these diseases. This article reviews the biologic basis of children's unique vulnerability to highly prevalent outdoor air pollutants, with a special focus on ozone, respirable particulate matter (PM 2.5 [<2.5 microm in diameter] and PM 10 [<10 microm in diameter]), lead, sulfur dioxide, carbon monoxide, and nitrogen oxides. We also summarize understanding regarding health effects and molecular mechanisms of action. Practitioners can significantly reduce morbidity in children and other vulnerable populations by advising families to minimize pollutant exposures to children with asthma, or at a broader level by educating policymakers about the need to act to reduce pollutant emissions. Management of children with asthma must expand beyond preventing exposures to agents that directly cause allergic reactions (and therefore can be diagnosed by means of skin tests) and must focus more attention on agents that cause a broad spectrum of nonspecific, generalized inflammation, such as air pollution.
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              Vital signs: asthma prevalence, disease characteristics, and self-management education: United States, 2001--2009.

              (2011)
              Most persons with asthma can be symptom-free if they receive appropriate medical care, use inhaled corticosteroids when prescribed, and modify their environment to reduce or eliminate exposure to allergens and irritants. This report reviews recent progress in managing asthma and reducing its prevalence in the United States. CDC analyzed asthma data from the 2001--2009 National Health Interview Survey concerning children and adults, and from the 2001, 2005, and 2009 state-based Behavioral Risk Factor Surveillance System concerning adults. Among persons of all ages, the prevalence of asthma increased from 7.3% (20.3 million persons) in 2001 to 8.2% (24.6 million persons) in 2009, a 12.3% increase. Prevalence among children (persons aged <18 years) was 9.6%, and was highest among poor children (13.5%) and among non-Hispanic black children (17.0%). Prevalence among adults was 7.7%, and was greatest in women (9.7%) and in adults who were poor (10.6%). More uninsured persons with asthma than insured could not afford to buy prescription medications (40.3% versus 11.5%), and fewer uninsured persons reported seeing or talking with a primary-care physician (58.8% versus 85.6%) or specialist (19.5% versus 36.9%). Among persons with asthma, 34.2% reported being given a written asthma action plan, and 68.1% had been taught the appropriate response to symptoms of an asthma attack. Only about one third of children or adults were using long-term control medicine such as inhaled corticosteroids at the time of the survey. CONCLUSIONS AND COMMENT: Persons with asthma need to have access to health care and appropriate medications and use them. They also need to learn self-management skills and practice evidence-based interventions that reduce environmental risk factors.
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                Author and article information

                Contributors
                Stephania Ann Cormier: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, USA )
                ISSN (Electronic): 1932-6203
                Publication date Collection: 2014
                Publication date (Electronic): 1 May 2014
                Volume: 9
                Issue: 5
                Electronic Location Identifier: e96190
                Affiliations
                [1 ]Department of Pediatrics, Chung Shan Medical University Hospital, Taichung City, Taiwan R.O.C
                [2 ]School of Medicine, Chung Shan Medical University, Taichung City, Taiwan R.O.C
                [3 ]Department of Health Policy and Management, Chung Shan Medical University, Taichung City, Taiwan R.O.C
                [4 ]Institute of Public Health, Department of Public Health, Chung Shan Medical University, Taichung City, Taiwan R.O.C
                University of Tennessee Health Science Center, United States of America
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: K.H. Lue HHP CTC. Performed the experiments: JYH JYP. Analyzed the data: K.H. Lue HLS JNS. Wrote the paper: HHP CTC. Reviewed the manuscript and gave input to the final version: HLS MSK PFL K.H. Lu JNS.

                Article
                Publisher ID: PONE-D-13-49838
                DOI: 10.1371/journal.pone.0096190
                PMC ID: 4006842
                PubMed ID: 24789041
                SO-VID: 46c56388-ca22-4b4d-b532-ff0924959925
                Copyright statement: Copyright @ 2014
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 26 November 2013
                Date accepted : 3 April 2014
                Page count
                Pages: 8
                Funding
                The authors have no support or funding to report.
                Categories
                Subject: Research Article
                Subject: Biology and Life Sciences
                Subject: Population Biology
                Subject: Earth Sciences
                Subject: Atmospheric Science
                Subject: Atmospheric Chemistry
                Subject: Air Quality
                Subject: Medicine and Health Sciences
                Subject: Epidemiology
                Subject: Environmental Epidemiology
                Subject: Pediatric Epidemiology
                Subject: Pediatrics
                Subject: Child Health
                Subject: Public and Occupational Health
                Subject: Pulmonology
                Subject: Asthma
                Subject: Physical Sciences
                Subject: Chemistry
                Subject: Environmental Chemistry

                ScienceOpen disciplines: Uncategorized
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                ScienceOpen disciplines: Uncategorized

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