Pollen and asthma morbidity in Atlanta: A 26-year time-series study

• Type of Material: Article
• Authors: Brooke Lappe, Emory University; Stefanie Ebelt, Emory University; Rohan DSouza, Emory University; Arie Manangan, Centers for Disease Control and Prevention; Claudia Brown, Centers for Disease Control and Prevention; Shubhayu Saha, Centers for Disease Control and Prevention; Drew Harris, University of Virginia; Howard Chang, Emory University; Adam Sole, Emory University; Noah C Scovronick, Emory University
• Language: English
• Date: 2023-06-03
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2023 The Authors. Published by Elsevier Ltd.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): https://doi.org/10.1016%2Fj.envint.2023.107998
• Title of Journal or Parent Work: Environment International
• Volume: 177
• Start Page: 107998
• Grant/Funding Information: This research was supported by grants to Emory University from the National Institute of Environmental Health Sciences (NIEHS) of the National Institutes of Health (NIH) under award numbers R01ES027892 and P30ES019776. Development of the emergency department visit database was also supported by grants to Emory University from the US Environmental Protection Agency (USEPA; R82921301), NIEHS (R01ES11294), and the Electric Power Research Institute (EP-P27723/C13172 and EP-P4353/C2124).
• Keywords: Pollen; Astha; disparities; Environmental epidemiology; Allergy
• Research Categories: Health Sciences, Epidemiology

Abstract

Background: Compared to many environmental risk factors, the relationship between pollen and asthma is understudied, including how associations may differ by pollen type and between subgroups, and how associations may be changing over time. Objectives: We evaluated the association between ambient pollen concentrations and emergency department (ED) visits for asthma and wheeze in Atlanta, Georgia during 1993–2018. We estimated overall associations for 13 individual pollen taxa, as well as associations by decade, race, age (5–17, 18–64, 65+), and insurance status (Medicaid vs non-Medicaid). Methods: Speciated pollen data were acquired from Atlanta Allergy & Asthma, a nationally certified pollen counting station. ED visit data were obtained from individual hospitals and from the Georgia Hospital Association. We performed time-series analyses using quasi-Poisson distributed lag models, with primary analyses assessing 3-day (lag 0–2 days) pollen levels. Models controlled for day of week, holidays, air temperature, month, year, and month-by-year interactions. Results: From 1993 to 2018, there were 686,259 ED visits for asthma and wheeze in the dataset, and the number of ED visits increased over time. We observed positive associations of asthma and wheeze ED visits with nine of the 13 pollen taxa: trees (maple, birch, pine, oak, willow, sycamore, and mulberry), two weeds (nettle and pigweed), and grasses. Rate ratios indicated 1–8% increases in asthma and wheeze ED visits per standard deviation increases in pollen. In general, we observed stronger associations in the earliest period (1993–2000), in younger people, and in Black patients; however, results varied by pollen taxa. Conclusions: Some, but not all, types of pollen are associated with increased ED visits for asthma/wheeze. Associations are generally higher in Black and younger patients and appear to have decreased over time.