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Objective: We investigated associations of short-term changes in ambient ozone (O3), fine particulate matter (PM2.5) and nitrogen dioxide (NO2) concentrations and the timing of new-onset asthma, using a large, high-risk population in an area with historically high ozone levels. Methods: The study population included 18,289 incident asthma cases identified among Medicaid-enrolled children in Harris County Texas between 2005–2007, using Medicaid Analytic Extract enrollment and claims files. We used a time-stratified case-crossover design and conditional logistic regression to assess the effect of increased short-term pollutant concentrations on the timing of asthma onset. Results: Each 10 ppb increase in ozone was significantly associated with new-onset asthma during the warm season (May–October), with the strongest association seen when a 6-day cumulative average period was used as the exposure metric (odds ratio [OR]=1.05, 95% confidence interval [CI], 1.02–1.08). Similar results were seen for NO2 and PM2.5 (OR=1.07, 95% CI, 1.03–1.11 and OR=1.12, 95% CI, 1.03–1.22, respectively), and PM2.5 also had significant effects in the cold season (November–April), 5-day cumulative lag (OR=1.11. 95% CI, 1.00–1.22). Significantly increased ORs for O3 and NO2 during the warm season persisted in co-pollutant models including PM2.5. Race and age at diagnosis modified associations between ozone and onset of asthma. Conclusion: Our results indicate that among children in this low-income urban population who developed asthma, their initial date of diagnosis was more likely to occur following periods of higher short-term ambient pollutant levels.
Wendt, J. K., E. Symanski, T. H. Stock, W. Chan, & X. L. Du (2014) Association of short-term increases in ambient air pollution and timing of initial asthma diagnosis among medicaid-enrolled children in a metropolitan area, Environmental Research 131:50-58.