A multicity study of air pollution and cardiorespiratory emergency department visits: Comparing approaches for combining estimates across cities

• Type of Material: Article
• Authors: Jenna Krall, Emory University; Howard Chang, Emory University; Lance Waller, Emory University; James A. Mulholland, Georgia Institute of Technology; Andrea Winquist, Emory University; Evelyn O. Talbott, University of Pittsburgh; Judith J. Rager, University of Pittsburgh; Paige Tolbert, Emory University; Stefanie Sarnat, Emory University
• Language: English
• Date: 2018-11-01
• Publisher: Pergamon-Elsevier Science Ltd
• Publication Version: Final Published Version
• Copyright Statement: © 2018 Elsevier Ltd
• Final Published Version (URL): http://dx.doi.org/10.1016/j.envint.2018.07.033
• Title of Journal or Parent Work: Environment International
• Volume: 120
• Start Page: 312
• End Page: 320
• Grant/Funding Information: Research reported in this publication was also supported by grants to Emory University from the USEPA (grant number R82921301), the National Institute of Environmental Health Sciences (grant number R01ES11294), and EPRI (grant numbers EP-P27723/C13172, EP-P4353/C2124, EP-P34975/C15892, EP-P45572/C19698, EP-P25912/C12525).; This publication was developed under Assistance Agreement No. EPA834799 awarded by the U.S. Environmental Protection Agency (USEPA) to Emory University and Georgia Institute of Technology as well as by funding from the Electric Power Research Institute (EPRI, grant number 10002467).
• Keywords: Life Sciences & Biomedicine; POLLUTANTS; Cardiorespiratory morbidity; Bayesian hierarchical models; FINE PARTICULATE MATTER; Time-series models; Health associations; EXPOSURE; MORTALITY; Environmental Sciences; HOSPITAL ADMISSIONS; PM2.5; Environmental Sciences & Ecology; ASSOCIATIONS; CHILDREN; Science & Technology; Air pollution; RESPIRATORY-DISEASES; SOURCE-APPORTIONMENT
• Research Categories: Environmental Sciences

Abstract

Determining how associations between ambient air pollution and health vary by specific outcome is important for developing public health interventions. We estimated associations between twelve ambient air pollutants of both primary (e.g. nitrogen oxides) and secondary (e.g. ozone and sulfate) origin and cardiorespiratory emergency department (ED) visits for 8 specific outcomes in five U.S. cities including Atlanta, GA; Birmingham, AL; Dallas, TX; Pittsburgh, PA; St. Louis, MO. For each city, we fitted overdispersed Poisson time-series models to estimate associations between each pollutant and specific outcome. To estimate multicity and posterior city-specific associations, we developed a Bayesian multicity multi-outcome (MCM) model that pools information across cities using data from all specific outcomes. We fitted single pollutant models as well as models with multipollutant components using a two-stage chemical mixtures approach. Posterior city-specific associations from the MCM models were somewhat attenuated, with smaller standard errors, compared to associations from time-series regression models. We found positive associations of both primary and secondary pollutants with respiratory disease ED visits. There was some indication that primary pollutants, particularly nitrogen oxides, were also associated with cardiovascular disease ED visits. Bayesian models can help to synthesize findings across multiple outcomes and cities by providing posterior city-specific associations building on variation and similarities across the multiple sources of available information.