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Short-term effects of ambient ozone on pediatric pneumonia hospital admissions: a multi-city case-crossover study in
Huan Wang1, Huan-Ling Zeng2, Guo-Xing Li3,4
1Department of Maternal and Child Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health.
Insights
Short-term exposure to ozone (O3) significantly increases the risk of pediatric pneumonia hospitalizations. This study highlights the need for stricter ozone pollution control to protect children's respiratory health.
Area of Science:
- Environmental Health
- Pediatric Pulmonology
- Epidemiology
Background:
- Children's respiratory health is highly sensitive to air pollution.
- Evidence linking short-term ozone (O3) exposure to childhood pneumonia is limited, particularly in LMICs.
Purpose of the Study:
- To investigate the association between short-term ozone exposure and pediatric pneumonia hospital admissions.
- To provide robust evidence on the health impacts of O3 pollution in children.
Main Methods:
- A multi-city, time-stratified case-crossover design was used with data from 7 children's hospitals in China (2016-2019).
- Individual-level medical records of 137,470 children under 6 diagnosed with pneumonia were analyzed.
- Conditional logistic regression and meta-analysis were employed to pool city-specific estimates.
Main Results:
- A 10 µg/m³ increase in O3 was associated with a 1.57% higher risk of pediatric pneumonia admissions (lag0-1).
- The association remained consistent across different sexes, age groups, and seasons.
- Ozone concentrations exceeding WHO Air Quality Guidelines showed a statistically significant increased risk.
Conclusions:
- A significant positive association exists between ozone exposure and pediatric pneumonia hospital admissions.
- Findings reinforce the detrimental health effects of ozone pollution.
- Ozone pollution control is crucial for reducing the burden of pediatric pneumonia.
Background:
Children's respiratory health demonstrates particular sensitivity to air pollution. Existing evidence investigating the association between short-term ozone (O3) exposure and childhood pneumonia remains insufficient and inconsistent, especially in low- and middle-income countries (LMICs).
Method:
To provide more reliable and persuasive evidence, we implemented a multi-city, time-stratified case-crossover design with a large sample size, using data from seven representative children's hospitals across major geographical regions in China. To avoid the impact of the COVID-19 pandemic, individual-level medical records of inpatient children under 6 years of age diagnosed with pneumonia during 2016-2019 were collected. Conditional logistic regression models were fitted for each city, and city-specific estimates were pooled through a meta-analysis using a random-effects model.
Results:
In total, the study included 137,470 pediatric pneumonia hospital admissions. The highest pooled estimate for O3 occurred at lag0-1, with a 10 µg/m3 increase in O3 associated with a 1.57% (95% CI: 0.67%-2.48%) higher risk of pediatric pneumonia hospital admissions. Stratified analyses indicated that the effects of O3 were robust across different sexes, age groups, and admission seasons. We also observed a statistically significant increase in risk associated with O3 concentrations exceeding the World Health Organization Air Quality Guidelines (WHO-AQGs).
Conclusions:
This study revealed a significant positive association between O3 and pediatric pneumonia hospital admissions. Our findings substantially strengthen the evidence base for the adverse health impacts of O3, underscoring the importance of O3 pollution control and management in reducing the public health burden of pediatric pneumonia.
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