STUDY AMBIENCE ZIP
We utilized information on each patient’s date of visit, principal diagnosis, residential ZIP code, and subsequent hospitalization (yes/no), as well as information on the patient’s age, race/ethnicity, sex, and expected method of payment. Inpatient visits reported date of admission, not ED presentation, so exposures were linked to that date. From PDD records, we included only hospitalizations originating in the ED. Records were compiled from the Emergency Department (ED) Data and the Patient Discharge Data (PDD), which covered outpatient and inpatient hospital visits, respectively. The California Office of Statewide Health Planning and Development provided cause-specific emergency visit data for 2005 through 2008 ( California Office of Statewide Health Planning and Development 2011).
We utilize these advantages to present an in-depth analysis, examining a population living near ozone monitors to reduce possible exposure misclassification. Additionally, its large, demographically diverse population allows us to explore possible effect modifiers of the relationships we may observe. California has numerous monitors for ozone and other gaseous pollutants, facilitating an examination of confounding by other air pollutants. In this study, we examined ozone exposure and respiratory EDVs in California, a state with both comprehensive records of EDVs and large variations in ozone levels, including areas failing to meet national and state Ambient Air Quality Standards. Thus, ozone studies could help illuminate consequences of both near-term and future exposure scenarios, quantify health impacts, and inform important policy decisions. Furthermore, a number of climate change models predict future increases in ozone related to rising temperatures in a number of regions ( Ebi and McGregor 2008). Characterizing how ozone exposures relate to these outcomes may help identify important biological mechanisms of airway disease and better delineate the breadth and scale of ozone’s impacts.
However, despite plausible hypotheses connecting ozone with other respiratory outcomes, links to EDVs for non-asthma outcomes have been less evident. Most ozone-respiratory EDV studies have focused on asthma, yielding a significant relationship when pooled in a review by Ji et al. 2001).Įmergency department visits (EDVs) greatly outnumber hospitalizations and can differ noticeably from them by diagnostic composition, demographics, quantity, and temporal characteristics ( Winquist et al. 2009), and school absences ( Gilliland et al. 2011), primary care physician visits ( Yamazaki et al. Furthermore, ozone exposure has been linked to increased mortality ( Bell et al. Studies have also associated chronic ozone exposures with the onset of asthma and long-term lung function reduction ( Fanucchi et al. These studies implicate oxidative stress pathways as the primary cause, as do studies of other pollutants such as particulates and nitrogen dioxide (NO 2) ( Ayres et al. Both experimental and observational studies have demonstrated ozone’s ability to decrease lung function, incite allergic and inflammatory responses, and promote airway hyperreactivity ( Mudway and Kelly 2000 U.S. The effects of ozone exposure on respiratory health have long been studied.
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