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Article: Air pollutants and health outcomes: Assessment of confounding by influenza

TitleAir pollutants and health outcomes: Assessment of confounding by influenza
Authors
KeywordsConfounding
Hong Kong
Hospitalization
Influenza activity
Mortality
Issue Date2010
PublisherPergamon. The Journal's web site is located at http://www.elsevier.com/locate/atmosenv
Citation
Atmospheric Environment, 2010, v. 44 n. 11, p. 1437-1442 How to Cite?
AbstractWe assessed confounding of associations between short-term effects of air pollution and health outcomes by influenza using Hong Kong mortality and hospitalization data for 1996-2002. Three measures of influenza were defined: (i) intensity: weekly proportion of positive influenza viruses, (ii) epidemic: weekly number of positive influenza viruses ≥4% of the annual number for ≥2 consecutive weeks, and (iii) predominance: an epidemic period with co-circulation of respiratory syncytial virus <2% of the annual positive isolates for ≥2 consecutive weeks. We examined effects of influenza on associations between nitrogen dioxide (NO 2), sulfur dioxide (SO 2), particulate matter with aerodynamic diameter ≤10 μm (PM 10) and ozone (O 3) and health outcomes including all natural causes mortality, cardiorespiratory mortality and hospitalization. Generalized additive Poisson regression model with natural cubic splines was fitted to control for time-varying covariates to estimate air pollution health effects. Confounding with influenza was assessed using an absolute difference of >0.1% between unadjusted and adjusted excess risks (ER%). Without adjustment, pollutants were associated with positive ER% for all health outcomes except asthma and stroke hospitalization with SO 2 and stroke hospitalization with O 3. Following adjustment, changes in ER% for all pollutants were <0.1% for all natural causes mortality, but >0.1% for mortality from stroke with NO 2 and SO 2, cardiac or heart disease with NO 2, PM 10 and O 3, lower respiratory infections with NO 2 and O 3 and mortality from chronic obstructive pulmonary disease with all pollutants. Changes >0.1% were seen for acute respiratory disease hospitalization with NO 2, SO 2 and O 3 and acute lower respiratory infections hospitalization with PM 10. Generally, influenza does not confound the observed associations of air pollutants with all natural causes mortality and cardiovascular hospitalization, but for some pollutants and subgroups of cardiorespiratory mortality and respiratory hospitalization there was evidence to suggest confounding by influenza. © 2010 Elsevier Ltd. All rights reserved.
Persistent Identifierhttp://hdl.handle.net/10722/86479
ISSN
2015 Impact Factor: 3.459
2015 SCImago Journal Rankings: 1.999
ISI Accession Number ID
Funding AgencyGrant Number
Health Effects Institute4713-RFIQ03-3/04-9
Funding Information:

This study was supported by grant 4713-RFIQ03-3/04-9 from the Health Effects Institute.

References
Grants

 

DC FieldValueLanguage
dc.contributor.authorThach, TQen_HK
dc.contributor.authorWong, CMen_HK
dc.contributor.authorChan, KPen_HK
dc.contributor.authorChau, YKen_HK
dc.contributor.authorNeil Thomas, Gen_HK
dc.contributor.authorOu, CQen_HK
dc.contributor.authorYang, Len_HK
dc.contributor.authorPeiris, JSMen_HK
dc.contributor.authorLam, THen_HK
dc.contributor.authorHedley, AJen_HK
dc.date.accessioned2010-09-06T09:17:33Z-
dc.date.available2010-09-06T09:17:33Z-
dc.date.issued2010en_HK
dc.identifier.citationAtmospheric Environment, 2010, v. 44 n. 11, p. 1437-1442en_HK
dc.identifier.issn1352-2310en_HK
dc.identifier.urihttp://hdl.handle.net/10722/86479-
dc.description.abstractWe assessed confounding of associations between short-term effects of air pollution and health outcomes by influenza using Hong Kong mortality and hospitalization data for 1996-2002. Three measures of influenza were defined: (i) intensity: weekly proportion of positive influenza viruses, (ii) epidemic: weekly number of positive influenza viruses ≥4% of the annual number for ≥2 consecutive weeks, and (iii) predominance: an epidemic period with co-circulation of respiratory syncytial virus <2% of the annual positive isolates for ≥2 consecutive weeks. We examined effects of influenza on associations between nitrogen dioxide (NO 2), sulfur dioxide (SO 2), particulate matter with aerodynamic diameter ≤10 μm (PM 10) and ozone (O 3) and health outcomes including all natural causes mortality, cardiorespiratory mortality and hospitalization. Generalized additive Poisson regression model with natural cubic splines was fitted to control for time-varying covariates to estimate air pollution health effects. Confounding with influenza was assessed using an absolute difference of >0.1% between unadjusted and adjusted excess risks (ER%). Without adjustment, pollutants were associated with positive ER% for all health outcomes except asthma and stroke hospitalization with SO 2 and stroke hospitalization with O 3. Following adjustment, changes in ER% for all pollutants were <0.1% for all natural causes mortality, but >0.1% for mortality from stroke with NO 2 and SO 2, cardiac or heart disease with NO 2, PM 10 and O 3, lower respiratory infections with NO 2 and O 3 and mortality from chronic obstructive pulmonary disease with all pollutants. Changes >0.1% were seen for acute respiratory disease hospitalization with NO 2, SO 2 and O 3 and acute lower respiratory infections hospitalization with PM 10. Generally, influenza does not confound the observed associations of air pollutants with all natural causes mortality and cardiovascular hospitalization, but for some pollutants and subgroups of cardiorespiratory mortality and respiratory hospitalization there was evidence to suggest confounding by influenza. © 2010 Elsevier Ltd. All rights reserved.en_HK
dc.languageengen_HK
dc.publisherPergamon. The Journal's web site is located at http://www.elsevier.com/locate/atmosenven_HK
dc.relation.ispartofAtmospheric Environmenten_HK
dc.subjectConfoundingen_HK
dc.subjectHong Kongen_HK
dc.subjectHospitalizationen_HK
dc.subjectInfluenza activityen_HK
dc.subjectMortalityen_HK
dc.titleAir pollutants and health outcomes: Assessment of confounding by influenzaen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=1352-2310&volume=44&spage=1437&epage=1442&date=2010&atitle=Air+pollutants+and+health+outcomes:+Assessment+of+confounding+by+influenzaen_HK
dc.identifier.emailThach, TQ: thach@hku.hken_HK
dc.identifier.emailWong, CM: hrmrwcm@hku.hken_HK
dc.identifier.emailPeiris, JSM: malik@hkucc.hku.hken_HK
dc.identifier.emailLam, TH: hrmrlth@hkucc.hku.hken_HK
dc.identifier.emailHedley, AJ: hrmrajh@hkucc.hku.hken_HK
dc.identifier.authorityThach, TQ=rp00450en_HK
dc.identifier.authorityWong, CM=rp00338en_HK
dc.identifier.authorityPeiris, JSM=rp00410en_HK
dc.identifier.authorityLam, TH=rp00326en_HK
dc.identifier.authorityHedley, AJ=rp00357en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.atmosenv.2010.01.036en_HK
dc.identifier.scopuseid_2-s2.0-77649329206en_HK
dc.identifier.hkuros169577en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-77649329206&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume44en_HK
dc.identifier.issue11en_HK
dc.identifier.spage1437en_HK
dc.identifier.epage1442en_HK
dc.identifier.isiWOS:000276736600007-
dc.publisher.placeUnited Kingdomen_HK
dc.relation.projectInteraction between air pollution and respiratory viruses: Time-series studies for daily mortality and hospital admissions-
dc.identifier.scopusauthoridThach, TQ=6602850066en_HK
dc.identifier.scopusauthoridWong, CM=7404954904en_HK
dc.identifier.scopusauthoridChan, KP=27171298000en_HK
dc.identifier.scopusauthoridChau, YK=16300609300en_HK
dc.identifier.scopusauthoridNeil Thomas, G=23568357900en_HK
dc.identifier.scopusauthoridOu, CQ=14070561800en_HK
dc.identifier.scopusauthoridYang, L=7406279703en_HK
dc.identifier.scopusauthoridPeiris, JSM=7005486823en_HK
dc.identifier.scopusauthoridLam, TH=7202522876en_HK
dc.identifier.scopusauthoridHedley, AJ=7102584095en_HK

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