Ozone pollution and asthma emergency department visits in the Central Valley, California, USA, during June to September of 2015: a time-stratified case-crossover analysis
Objective: The San Joaquin Valley (SJV) exceeds the state and national standards for ozone (O3). This study investigates whether short term exposure to O3 is associated with asthma emergency department (ED) visits. Methods: We identified 1101 ED visits in June-September of 2015 in SJV, California, who lived within 15 km of active air monitors. Conditional logistic regression models were used to obtain the odds ratio (OR) and 95% confidence interval (CI) associated with an interquartile (IQR) increase in ozone. We explored potential effect modification by sex (female, and male), race (White, Black, and Hispanic), age (2-5, 6-18, 19-40, 41-64 and >= 65), and by county (Merced, Madera, Kings, Fresno and Kern). Results: An interquartile range (18.1 ppb) increase in O3 exposure three days before an asthma attack (lag 3) was associate with a 6.6% [OR: 1.066 (95% CI: 1.032, 1.082)] increase in the odds of having an asthma ED visit. The overall ORs differed across age groups and races/ethnicities, with strongest for children aged 6–18 years [OR: 1.219 (95% CI: 1.159, 1.280)] and adults 19-40 years [OR: 1.102 (95% CI: 1.053, 1.154)], and Blacks [OR: 1.159 (95% CI: 1.088, 1.236)], respectively. O3 exposure was not positively associated with asthma ED visits for Whites while it was for other underrepresented groups. Fresno had the highest number of asthma ED visits and positive association among all five counties. Conclusion: We found that O3 exposure is associated with asthma ED visits in the SJV.