Neighborhood environmental factors linked to hospitalizations of older people for viral lower respiratory tract infections in Spain: a case-crossover study

Abstract

Background Lower respiratory tract viral infection (LRTI) is a significant cause of morbidity-mortality in older people worldwide. We analyzed the association between short-term exposure to environmental factors (climatic factors and outdoor air pollution) and hospital admissions with a viral LRTI diagnosis in older adults. Methods We conducted a bidirectional case-crossover study in 6367 patients over 65 years of age with viral LRTI and residential zip code in the Spanish Minimum Basic Data Set. Spain’s State Meteorological Agency was the source of environmental data. Associations were assessed using conditional logistic regression. P-values were corrected for false discovery rate (q-values). Results Almost all were hospital emergency admissions (98.13%), 18.64% were admitted to the intensive care unit (ICU), and 7.44% died. The most frequent clinical discharge diagnosis was influenza (90.25%). LRTI hospital admissions were more frequent when there were lower values of temperature and O3 and higher values of relative humidity and NO2. The regression analysis adjusted by temperatures and relative humidity showed higher concentrations at the hospital admission for NO2 [compared to the lag time of 1-week (q-value< 0.001) and 2-weeks (q-value< 0.001)] and O3 [compared to the lag time of 3-days (q-value< 0.001), 1-week (q-value< 0.001), and 2-weeks (q-value< 0.001)] were related to a higher odds of hospital admissions due to viral LRTI. Moreover, higher concentrations of PM10 at the lag time of 1-week (q-value = 0.023) and 2-weeks (q-value = 0.002), and CO at the lag time of 3-days (q-value = 0.023), 1-week (q-value< 0.001) and 2-weeks (q-value< 0.001)], compared to the day of hospitalization, were related to a higher chances of hospital admissions with viral LRTI. Conclusion Unfavorable environmental factors (low temperatures, high relative humidity, and high concentrations of NO2, O3, PM10, and CO) increased the odds of hospital admissions with viral LRTI among older people, indicating they are potentially vulnerable to these environmental factors. Graphical Abstract

Comparison of the association between different ozone indicators and daily respiratory hospitalization in Guangzhou, China

“…During the cold period, the two O 3 indicators were significantly and negatively associated with respiratory hospitalization visits, with a higher risk in the 60+ age group than that in the 15–60 age group. These results are consistent with studies from other time-series studies ( 40 ).…”

The Environmental Sustainability Assessment of an Orthopedics Emergency Hospital Supported by a New Innovative Framework

“…In our study, we showed that although medical equipment and modern high-performance medical equipment that are recently purchased have low electricity usage, they still contribute substantially to the hospital's energy consumption, as Abraham and Reddy also pointed out [63]. Unlike other hospitals investigated by Álvaro-Meca et al [92], environmental factors at CECHTM are not monitored in all departments and do not allow for investigation of the increased number of hospitalizations due to respiratory infections.…”

“…Álvaro-Meca et al [92] showed that, among the elderly, the chances of hospitalization with lower respiratory tract viral infection was increased upon exposure to unfavorable environmental factors such as high humidity, low temperatures, and high concentrations of CO, PM10, O 3 , and NO 2 .…”

Seasonal extreme temperatures and short-term fine particulate matter increases pediatric respiratory healthcare encounters in a sparsely populated region of the intermountain western United States

“…These results are in line with past studies showing LRTI to be a significant cause of hospitalizations, morbidity, and mortality worldwide with seasonal climate factors being associated with a higher probability of infection [ 24 ]. For example, Alvaro-Meca et al [ 3 ] found that LRTI hospital visits were more frequent during lower temperatures. And Mäkinen et al [ 60 ] demonstrated that cold temperatures were associated with increased occurrences of LRTI and a decrease in temperature preceded the onset of infections.…”