Ambient air pollution is associated with pediatric pneumonia: a time-stratified case–crossover study in an urban area

BACKGROUND: Pneumonia, the leading reason underlying childhood deaths, may be triggered or exacerbated by air pollution. To date, only a few studies have examined the association of air pollution with emergency department (ED) visits for pediatric pneumonia, with inconsistent results. Therefore, we aimed to elucidate the impact of short-term exposure to particulate matter (PM) and other air pollutants on the incidence of ED visits for pediatric pneumonia. METHODS: PM(2.5), PM(10), and other air pollutant levels were measured at 11 air quality-monitoring stations in Kaohsiung City, Taiwan, between 2008 and 2014. Further, we extracted the medical records of non-trauma patients aged ≤17 years and who had visited an ED with the principal diagnosis of pneumonia. A time-stratified case–crossover study design was employed to determine the hazard effect of air pollution in a total of 4024 patients. RESULTS: The single-pollutant model suggested that per interquartile range increment in PM(2.5), PM(10), nitrogen dioxide (NO(2)), and sulfur dioxide (SO(2)) on 3 days before the event increased the odds of pediatric pneumonia by 14.0% [95% confidence interval (CI), 5.1–23.8%], 10.9% (95% CI, 2.4–20.0%), 14.1% (95% CI, 5.0–24.1%), and 4.5% (95% CI, 0.8–8.4%), respectively. In two-pollutant models, PM(2.5) and NO(2) were significant after adjusting for PM(10) and SO(2). Subgroup analyses showed that older children (aged ≥4 years) were more susceptible to PM(2.5) (interaction p = 0.024) and children were more susceptible to NO(2) during warm days (≥26.5 °C, interaction p = 0.011). CONCLUSIONS: Short-term exposure to PM(2.5) and NO(2) possibly plays an important role in pediatric pneumonia in Kaohsiung, Taiwan. Older children are more susceptible to PM(2.5), and all children are more susceptible to NO(2) during warm days.