Abstract
BACKGROUND: Many studies have evaluated associations between asthma emergency department (ED) visits, hospital admissions (HAs), and ambient ozone (O(3)) across the US, but not in Texas. We investigated the relationship between O(3) and asthma HAs, and the potential impacts of outdoor pollen, respiratory infection HAs, and the start of the school year in Texas. METHODS: We obtained daily time-series data on asthma HAs and ambient O(3) concentrations for Dallas, Houston, and Austin, Texas for the years 2003-2011. Relative risks (RRs) and 95% confidence intervals (CIs) of asthma HAs per 10-ppb increase in 8-h maximum O(3) concentrations were estimated from Poisson generalized additive models and adjusted for temporal trends, meteorological factors, pollen, respiratory infection HAs, day of the week, and public holidays. We conducted a number of sensitivity analyses to assess model specification. RESULTS: We observed weak associations between total asthma HAs and O(3) at lags of 1 day (RR(10 ppb) = 1.012, 95% CI: 1.004-1.021), 2 days (RR(10 ppb) = 1.011, 95% CI: 1.002-1.019), and 0-3 days (RR(10 ppb) = 1.017, 95% CI: 1.005-1.030). The associations were primarily observed in children aged 5-14 years (e.g., for O(3) at lag 0-3 days, RR(10 ppb) = 1.037, 95% CI: 1.011-1.064), and null in individuals 15 years or older. The effect estimates did not change significantly with adjustment for pollen and respiratory infections, but they attenuated considerably and lost statistical significance when August and September data were excluded. A significant interaction between time around the start of the school year and O(3) at lag 2 day was observed, with the associations with pediatric asthma HAs stronger in August and September (RR(10 ppb) = 1.040, 95% CI: 1.012-1.069) than in the rest of the year (October-July) (RR(10 ppb) = 1.006, 95% CI: 0.986-1.026). CONCLUSIONS: We observed small but statistically significant positive associations between total and pediatric asthma HAs and short-term O(3) exposure in Texas, especially in August and September. Further research is needed to determine how the start of school could modify the observed association between O(3) and pediatric asthma HAs.