Ambient Air Quality and Pediatric Asthma Morbidity: Sociodemographic Influences Open Access

O'Lenick, Cassandra Ruth (2016)

Permanent URL: https://etd.library.emory.edu/concern/etds/2801pg819?locale=en
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Abstract

Introduction. Increasing evidence suggests that ambient air quality (e.g., ambient air pollution and high ambient temperature) is associated with asthma morbidity among children. Susceptibility to the health effects of ambient air quality may be influenced by sociodemographic factors at both the individual (e.g. sex, race/ethnicity, insurance status) and neighborhood level, such as neighborhood socioeconomic status (SES). However, epidemiologic research has provided inconsistent findings on whether individual- and/or neighborhood-level factors modify short-term associations between ambient air quality and respiratory morbidity, particularly across different study areas. In this dissertation I examined the degree to which individual- and/or neighborhood-level factors influence air quality-related respiratory emergency department (ED) visits among children 5-18 years old.

Methods. In Chapter 1, conditional logistic regression (CLR) was used to estimate associations between air pollution and pediatric asthma ED visits in Atlanta. Effect modification by ZIP Code Tabulation Area (ZCTA) SES was examined via stratification. In Chapter 2, a 2-stage modeling approach (CLR followed by a Bayesian hierarchical meta-regression) was used to estimate associations between ozone-related pediatric respiratory ED visits and to examine effect modification by neighborhood SES across multiple US cities (Atlanta, Dallas, and St. Louis). In Chapter 3, Poisson regression was used to estimate associations between high temperature and asthma ED visits. Effect modification by sex, race/ethnicity, insurance status (a proxy for individual-level SES), and neighborhood SES was examined via stratification.

Results. Findings from Chapters 1 and 2 suggest that air pollution is associated with pediatric respiratory morbidity in multiple US cities and that neighborhood SES may modify this association in a non-linear manner. Findings from Chapter 3 suggest stronger associations between high temperature and asthma morbidity among males compared to females, non-white children compared to white children, children with private insurance compared to children with Medicaid, and among children living in high compared to low SES neighborhoods.

Conclusion. Short-term ambient air quality is associated with increases in pediatric respiratory morbidity in multiple US cities; individual and neighborhood-level sociodemographic factors may confer vulnerability. Findings from this research can help identify vulnerable subpopulations in our study areas and may inform risk assessment and targeted prevention strategies.

Table of Contents

Table of Contents

Preamble…………………………………………………………………………………..1

Introduction………………………………………………………………………………2

Dissertation Aims…………………………………………………………………..6

References………………………………………………………………………….9

Chapter 1: Assessment of neighborhood-level socioeconomic status as a modifier of air pollution-asthma associations among children in Atlanta………………………………………………………………………...................19

Abstract…………………………………………………………………………...20

Introduction……………………………………………………….………...…….21

Methods……………………………………………………………………….….23

Results…………………………………………………………………………….28

Discussion……………………………………………………………………..….35

References………………………………………………………………………...40

Supplemental Tables/Figures……………………………………………………...46

Appendix 1: Conditional Logistic Regression Equation…...………….……………54

Appendix 2: Sensitivity Analyses…………………………………………………..56

Appendix 3: Neighborhood Characterization……………………….……………..58

Chapter 2: Ozone and childhood respiratory disease in three US cities: evaluation of effect measure modification by neighborhood socioeconomic status using a Bayesian hierarchal approach………………………………………………………..……………63

Abstract…………………………………………………………………………...64

Background.……………………………………………………….………...…….66

Methods……………………………………………………………………….….68

Results…………………………………………………………………………….74

Discussion……………………………………………………………………..….85

References………………………………………………………………………...93

Supplemental Tables/Figures……………………………………………...………98

Chapter 3: Evaluation of individual and neighborhood factors as modifiers of the association between warm-season temperature and pediatric asthma morbidity in Atlanta, GA………………………………………………………..…...……………….102

Abstract……………………………………………………………………….....103

Background.……………………………………………………….………......…104

Methods…………………………………………………………………………107

Results………………………………………………………………………...…111

Discussion……………………………………………………………………….124

References…………………………………………………………………….....133

Supplemental Tables/Figures……………………………………………………142

Conclusion……………………………………………………………………………...148

Contributions……………………………………………………………………148

Limitations………………………………………………………………………151

Conclusions……………………………………………………………………...152

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