Association between chronic exposure to air pollution and mortality in the acute respiratory distress syndrome

Abstract

The impact of chronic exposure to air pollution and outcomes in the acute respiratory distress syndrome (ARDS) is unknown. The Nationwide Inpatient Sample (NIS) from 2011 was utilized for this analysis. The NIS is a national database that captures 20% of all US in-patient hospitalizations from 47 states. Patients with ARDS who underwent mechanical ventilation from the highest 15 ozone pollution cities were compared with the rest of the country. Secondary analyses assessed outcomes of ARDS patients for ozone pollution and particulate matter pollution on a continuous scale by county of residence. A total of 8,023,590 hospital admissions from the 2011 NIS sample were analyzed. There were 93,950 patients who underwent mechanical ventilation for ARDS included in the study. Patients treated in high ozone regions had significantly higher unadjusted hospital mortality (34.9% versus 30.8%, p < 0.01) than patients in cities with control levels of ozone. After controlling for all variables in the model, treatment in a hospital located in a high ozone pollution area was associated with an increased odds of in-hospital mortality (OR 1.11, 95% CI 1.08–1.15, p < 0.01). After adjustment for all variables in the model, for each increase in ozone exposure by 0.01 ppm the OR for death was 1.07 (95% CI 1.06–1.08, p < 0.01). Similarly, for each increase in particulate matter exposure by 10 μg/m3, the OR for death was 1.08 (95% CI 1.02–1.16, p < 0.01). Chronic exposure to both ozone and particulate matter pollution is associated with higher rates of mortality in ARDS. These preliminary findings need to be confirmed by further detailed studies.

Long-term exposure to NO2 and O3 and all-cause and respiratory mortality: A systematic review and meta-analysis

“…Twelve studies reported results for all-year O 3 exposure and all-cause mortality ( Table 3 a). We selected the most recent study results for meta-analyses, therefore three studies ( Health Effects Institute, 2000 , Jerrett et al, 2013 , Jerrett et al, 2009 ) were excluded and nine studies ( Health Effects Institute, 2000 , Lipsett et al, 2011 , Carey et al, 2013 , Turner et al, 2016 , Desikan et al, 2015 , Abbey et al, 1999 , Lipfert et al, 2006 , Tonne et al, 2016 , Rush et al, 2017 )were included for main analysis (note: one study ( Health Effects Institute, 2000 ) included two cohorts, results from one cohort was included, the other was excluded) ( Fig. 6 ).…”

“…A small number of studies examined the shape of the concentration response relationships for O 3 and mortality. Turner 2016 ( Turner et al, 2016 ) analysing the American Cancer Society (ACS) cohort reported evidence that a threshold model (35 ppb) offered an improved fit over the linear model for annual O 3 concentrations and both respiratory and cardiovascular mortality ( Rush et al, 2017 ). Using thin-plate–spline models, Di ( Di et al, 2017 ) reported a relationship between O 3 and all-cause mortality that was almost linear, with no signal of a threshold down to 30 ppb.…”

Interactive effects of changing stratospheric ozone and climate on tropospheric composition and air quality, and the consequences for human and ecosystem health

“…Mortality from acute respiratory distress syndrome (ARDS) was associated with exposure to O3 and particulate matter. 99 After controlling for other (unstated) variables in the model, treatment in a hospital located in an area with high O3 was associated with an increased odds ratio (OR e ) of mortality of 1.11 (95% CI; 1.08-1.15, p < 0.01) for in-hospital mortality. Adjusting for all factors, for each 20-µg m -3 increment in the concentration of O3, the OR for mortality was 1.07 (95% CI; 1.06-1.08, p < 0.01).…”

Protective influence of healthful nutrition on mechanisms of environmental pollutant toxicity and disease risks

“…For example, short‐term exposure to particulate matter (PM 2.5 ), NO 2 , and ozone is associated with lower forced vital capacity and lower forced expiratory volume . Additionally, a recent study reported that, in adult patients with acute respiratory distress syndrome, chronic exposure to air pollution (i.e., ozone and particulate matter (PM)) is associated with an increase rate of mortality . Importantly, the initiation of inflammatory responses within the lungs from pollutant exposure can affect other organ systems, contributing to further disease pathologies .…”

“…8 Additionally, a recent study reported that, in adult patients with acute respiratory distress syndrome, chronic exposure to air pollution (i.e., ozone and particulate matter (PM)) is associated with an increase rate of mortality. 9 Importantly, the initiation of inflammatory responses within the lungs from pollutant exposure can affect other organ systems, contributing to further disease pathologies. 10 For example, acute or chronic exposure to airborne PM can accelerate the pathology of atherosclerosis through increases in vascular inflammation, macrophage infiltration, and generation of reactive oxygen species.…”