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Meteorological factors, air pollutants, and emergency department visits for otitis media: a time series study

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Abstract

Otitis media (OM) is a very common disease in children, which results in a significant economic burden to the healthcare system for hospital-based outpatient departments, emergency departments (EDs), unscheduled medical examinations, and antibiotic prescriptions. The aim of this retrospective observational study is to investigate the association between climate variables, air pollutants, and OM visits observed in the 2007–2010 period at the ED of Cuneo, Italy. Measures of meteorological parameters (temperature, humidity, atmospheric pressure, wind) and outdoor air pollutants (particulate matter, ozone, nitrous dioxide) were analyzed at two statistical stages and in several specific steps (crude and adjusted models) according to Poisson’s regression. Response variables included daily examinations for age groups 0–3, 0–6, and 0–18. Control variables included upper respiratory infections (URI), flu (FLU), and several calendar factors. A statistical procedure was implemented to capture any delayed effects. Results show a moderate association for temperature (T), age 0–3, and 0–6 with P < 0.05, as well as nitrous dioxide (NO2) with P < 0.005 at age 0–18. Results of subsequent models point out to URI as an important control variable. No statistical association was observed for other pollutants and meteorological variables. The dose–response models (DLNM—final stage) implemented separately on a daily and hourly basis point out to an association between temperature (daily model) and RR 1.44 at age 0–3, CI 1.11–1.88 (lag time 0–1 days) and RR 1.43, CI 1.05–1.94 (lag time 0–3 days). The hourly model confirms a specific dose–response effect for T with RR 1.20, CI 1.04–1.38 (lag time range from 0 to 11 to 0–15 h) and for NO2 with RR 1.03, CI 1.01–1.05 (lag time range from 0 to 8 to 0–15 h). These results support the hypothesis that the clinical context of URI may be an important risk factor in the onset of OM diagnosed at ED level. The study highlights the relevance of URI as a control variable to be included in the statistical analysis in association with meteorological factors and air pollutants. The study also points out to a moderate association of OM with low temperatures and NO2, with specific risk factors for this variable early in life. Further studies are needed to confirm these findings, particularly with respect to air pollutants in larger urban environments.

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References

  • Aguilera I, Pedersen M, Garcia-Esteban R, Ballester F, Basterrechea M, Esplugues A, Fernández-Somoano A, Lertxundi A, Tardón A, Sunyer J (2013) Early-life exposure to outdoor air pollution and respiratory health, ear infections, and eczema in infants from the INMA study. Environ Health Perspect 121(3):387–392

    Google Scholar 

  • Barnett AG, Hajat S, Gasparrini A, Rocklöv J (2012) Cold and heat waves in the United States. Environ Res 112(1):218–224

    Article  CAS  Google Scholar 

  • Bhattacharyya N, Shapiro NL (2010) Air quality improvement and the prevalence offrequent ear infections in children. Otolaryngol Head Neck Surg 142(2):242–246

    Article  Google Scholar 

  • Biggeri A, Bellini P, Terracini B, Italian MISA Group (2001) Meta-analysis of the Italian studies on short-term effects of air pollution. Epidemiol Prev 25(2 Suppl):1–71

    CAS  Google Scholar 

  • Block SL, Heikkinen T, Toback SL, Zheng W, Ambrose CS (2011) The efficacy of live attenuated influenza vaccine against influenza-associated acute otitis media in children. Pediatr Infect Dis J 30(3):203–207

    Article  Google Scholar 

  • Bluestone CD, Klein JO (2001) Otitis media in infants and children, 3rd ed. 2001 edn. WB Saunders, Philadelphia

  • Brauer M, Gehring U, Brunekreef B, de Jongste J, Gerritsen J, Rovers M, Wichmann HE, Wijga A, Heinrich J (2006) Traffic-related air pollution and otitis media. Environ Health Perspect 114(9):1414–1418

    Article  CAS  Google Scholar 

  • Casselbrant ML, Mandel EM, Jung J, Ferrell RE, Tekely K, Szatkiewicz JP, Ray A, Weeks DE (2009) Otitis media: agenome-wide linkage scan with evidence of susceptibilityloci within the 17q12 and 10q22.3 regions. BMC Med Genet 10(85):1–10

    Google Scholar 

  • Centro Interuniversitario di Ricerca sull’Influenza e le altre Infezioni Trasmissibili (2012). Stagioniprecedenti [Online]. Available: http://www.cirinet.it/jm/sorveglianza-virologica/stagioni-precedenti/clinico-epidemiologica.html[Accessed 9 Apr 2015]

  • Cesaroni G, Badaloni C, Porta D, Forastiere F, Perucci CA (2008) Comparison between various indices of exposure to traffic-related air pollution and their impact on respiratory health in adults. Occup Environ Med 65(10):683–690

    Article  CAS  Google Scholar 

  • Chauhan AJ, Johnston SL (2003) Air pollution and infection in respiratory illness. Br Med Bull 68:95–112

    Article  CAS  Google Scholar 

  • Chonmaitree T, Revai K, Grady JJ, Clos A, Patel JA, Nair S, Fan J, Henrickson KJ (2008) Viral upper respiratory tract infection and otitis media complication in young children. Clin Infect Dis 46(6):815–823

    Article  Google Scholar 

  • Collana di Studi Climatologici in Piemonte (1998) Regione Piemonte. Dip. di Scienze della Terra, Università degli Studi di Torino

  • Colleen ER, Snowden JM, Kontgis C, Tager IB (2012) The role of ambient ozone in epidemiologicstudies of heat-relatedmortality. Environ Health Perspect 120:1627–1630

    Google Scholar 

  • Danet S, Richard F, Montaye M, Beauchant S, Lemaire B, Graux C, Cottel D, Marécaux N, Amouyel P (1999) Unhealthy effects of atmospheric temperature and pressure on the occurrence of myocardial infarction and coronary deaths. A 10-year survey: the Lille-World Health Organization MONICA project (Monitoring trends and determinants in cardiovascular disease). Circulation 100(1):E1–E7

    Article  CAS  Google Scholar 

  • Darrow LA, Klein M, Flanders WD, Mulholland JA, Tolbert PE, Strickland MJ (2014) Air pollution and acute respiratory infections among children 0-4 years of age: an 18-year time-series study. Am J Epidemiol 180(10):968–977

    Article  Google Scholar 

  • Falagas ME, Theocharis G, Spanos A, Vlara LA, Issaris EA, Panos G, Peppas G (2008) Effect of meteorological variables on the incidence of respiratory tract infections. Respir Med 102(5):733–737

    Article  Google Scholar 

  • Fleming DM, Taylor RJ, Haguinet F, Schuck-Paim C, Logie J, Webb DJ, Lustig RL, Matias G (2016) Influenza-attributable burden in United Kingdom primary care. Epidemiol Infect. 2016. Feb 144(3):537–547

    CAS  Google Scholar 

  • Frampton MW, Boscia J, Roberts NJ Jr, Azadniv M, Torres A, Cox C, Morrow PE, Nichols J, Chalupa D, Frasier LM, Gibb FR, Speers DM, Tsai Y, Utell MJ (2002) Nitrogen dioxide exposure: effectson airway and blood cells. Am J Physiol Lung Cell Mol Physiol 282:L155–L165

    CAS  Google Scholar 

  • Funakubo M, Sato J, Obata K, Mizumura K (2011) The rate and magnitude of atmospheric pressure change that aggravate pain-related behavior of nerve injured rats. Int J Biometeorol 55(3):319–326

    Article  Google Scholar 

  • Gasparrini A (2013) Distributed lag linear and non-linear models in R: the package dlnm. J Stat Softw 43(8):1–20

    Google Scholar 

  • Gasparrini A (2014) Modeling exposure–lag–response associations with distributed lag non-linear models. Stat Med 33(5):881–899

    Article  Google Scholar 

  • Håberg SE, Bentdal YE, London SJ, Kvaerner KJ, Nystad W, Nafstad P (2011) Prenatal and postnatal parental smoking and acute otitismedia in early childhood. Acta Paediatr 99(1):99–105

    Google Scholar 

  • Heinrich J, Raghuyamshi VS (2004) Air pollution and otitis media: a review of evidence from epidemiologic studies. Curr Allergy Asthma Rep 4(4):302–309

    Article  Google Scholar 

  • Helleday R, Huberman D, Blomberg A, Stjernberg N, Sandström T (1995) Nitrogen dioxide exposure impairs the frequency of the mucociliary activity in healthy subjects. Eur Respir J 8 8(10):1664–1668

    Article  CAS  Google Scholar 

  • Hoffman JH, Daly KA, Bainbridge KE, Casselbrant ML, Homøe P, Kvestad E, Kvaerner KJ, Vernacchio L (2013) Panel 1: epidemiology, natural history, and risk factors. Otolaryngol Head Neck Surg 148(4S):E1–E25

    Article  Google Scholar 

  • Kahle JJ, Neas LM, Devlin RB, Case MW, Schmitt MT, Madden MC, Diaz-Sanchez D (2015) Interaction effects of temperature and ozone on lung function and markers of systemic inflammation, coagulation, and fibrinolysis: a crossover study of healthy young volunteers. Environ Health Perspect 123(4):310–316

    CAS  Google Scholar 

  • Kalu SU, Ataya RS, McCormick DP, Patel JA, Revai K, Chonmaitree T (2011) Clinical spectrum of acute otitis media complicatingupper respiratory tract viral infection. Pediatr Infect Dis J30:95–99

    Article  Google Scholar 

  • Katsouyanni K, Touloumi G, Samoli E, Gryparis A, Le Tertre A, Monopolis Y, Rossi G, Zmirou D, Ballester F, Boumghar A, Anderson HR, Wojtyniak B, Paldy A, Braunstein R, Pekkanen J, Schindler C, Schwartz J (2001) Confounding and effect modification in the shortterm effects of ambient particles on total mortality: results from 29 European cities within the APHEA2 project. Epidemiology 12(5):521–531

    Article  CAS  Google Scholar 

  • Koch A, Homøe P, Pipper C, Hjuler T, Melbye M (2011) Chronic suppurative otitis media in a birth cohort of children in Greenland: population-based study of incidence and risk factors. Pediatr Infect Dis J30:25–29

    Article  Google Scholar 

  • Kousha T, Castner J (2016) The air quality health index and emergency department visits for otitis media. J Nurs Scholars 48(2):163–171

    Article  Google Scholar 

  • Lasisi AO, Olaniyan FA, Muibi SA, Azeez IA, Abdulwasiu KG, Lasisi TJ, Imam ZO, Yekinni TO, Olayemi O (2007) Clinical and demographicrisk factors associated with chronic suppurative otitismedia. Int J Pediatr Otorhinolaryngol 71(10):1549–1554

    Article  Google Scholar 

  • Lin S, Luo M, Walker RJ, Liu X, Hwang SA, Chinery R (2009) Extreme high temperatures and hospital admissions for respiratory and cardiovascular diseases. Epidemiology 20(5):738–746

    Article  Google Scholar 

  • MacIntyre EA, Gehringet U et al (2014) Air pollution and respiratory infections during early childhood: an analysis of 10 European birth cohorts within the ESCAPE project. Environ Health Perspect 122(1):107–113

    Google Scholar 

  • MacIntyre EA, Karr CJ, Koehoorn M, Demers PA, Tamburic L, Lencar C, Brauer M (2011) Residential air pollution and otitis media during the first two years of life. Epidemiology 22(1):81–89

    Article  Google Scholar 

  • Makinen TM, Juvonen R, Jokelainen J, Harju TH, Peitso A, Bloigu A, Silvennoinen-Kassinen S, Leinonen M, Hassi J (2009) Cold temperature and low humidity are associated with increased occurrence of respiratory tract infections. Respir Med 103:456–462

    Article  Google Scholar 

  • Mandel EM, Doyle WJ, Winther B, Alper CM (2008) The incidence, prevalence and burden of OM in unselected children aged 1-8 years followed by weekly otoscopy through the “common cold” season. Int J Pediatr Otorhinolaryngol 72:491–499

    Article  Google Scholar 

  • Marchisio P, Cantarutti L, Sturkenboom M et al (2012) Burden of acute otitis media in primary care pediatrics: a secondary data analysis from the Pedianet database. BMC Pediatr 12:185

    Article  Google Scholar 

  • McCormick DP, Grady JJ, Diego A, Matalon R, Revai K, Patel JA, Han Y, Chonmaitree T (2011) Acute otitis media severity: association with cytokine gene polymorphisms and other riskfactors. Int J Pediatr Otorhinolaryngol 75:708–712

    Article  Google Scholar 

  • Michelozzi P, Accetta G, De Sario M, D’Ippoliti D, Marino C, Baccini M, Biggeri A, Ander-son HR, Katsouyanni K, Ballester F, Bisanti L, Cadum E, Forsberg B, Forastiere F, Goodman PG, Hojs A, Kirchmayer U, Medina S, Paldy A, Schindler C, Sunyer J, Perucci CA (2009) High temperature and hospitalizations for cardiovascular and respiratory causes in 12 european cities. Am J Respir Crit Care Med 179:383–389

    Article  Google Scholar 

  • Miller ME, Shapiro NL, Bhattacharyya NA (2012) Annual temperature and the prevalence of frequent ear infections in childhood. Am J Otolaryngol 33(1):51–55

    Article  Google Scholar 

  • Nastos PT, Matzarakis A (2006) Weather impacts on respiratory infections in Athens, Greece. Int J Biometeorol 50:358–369

    Article  Google Scholar 

  • National Center for Health Statistics, Centers for Disease Control and Prevention, Department of Health and Human Services (2011) Healthy People 2010; Final Review; Focus Area 28 (Objective 12):28–13 www.cdc.gov/nchs/data/hpdata2010/hp2010_final_review.pdf

  • Patel JA, Nguyen DT, Revai K, Chonmaitree T (2007) Role of respiratorysyncytial virus in acute otitis media: implications for vaccinedevelopment. Vaccine 25(9):1683–1689

    Article  CAS  Google Scholar 

  • Peterson TC, Easterling DR (1994) Creation of homogeneous compositeclimatological reference series. Int J Climatol 14:691–679

    Article  Google Scholar 

  • Qin S, Hongsheng L, Xiaoling Y, Yan X, Xian Z, Rongju S, Wei D, Jianbo Z, Yuhong Q, Baozhong M, Xiaodong Z (2014) The interaction effects of temperature and humidity on emergency room visits for respiratory diseases in Beijing, China. Cell Biochem Biophys 70:1377–1384

    Article  Google Scholar 

  • Ranzi A, Porta D, Badaloni C, Cesaroni G, Lauriola P, Davoli M, Forastiere F (2014) Exposure to air pollution and respiratory symptoms during 7 years of life in an Italian birth cohort. Occup Environ Med 71(6):430–436

    Article  CAS  Google Scholar 

  • Ren C, Williams GM, Morawska L, Mengersen K, Tong S (2008) Ozone modifies associations between temperature and cardiovascular mortality: analysis of the NMMAPS data. Occup Environ Med 65(4):255–260

    Article  CAS  Google Scholar 

  • Rovers MM, Schilder AG, Zielhuis GA, Rosenfeld RM (2004) Otitis media. Lancet 363:465–473

    Article  Google Scholar 

  • Salah M, Abdel-Aziz M, Al-Farok A, Jebrini A (2013) Recurrent acute otitis media in infants: analysis of risk factors. Int J Pediatr Otorhinolaryngol 77(10):1665–1669

    Article  Google Scholar 

  • Samet JM, Zeger SL, Dominici F, Curriero F, Coursac I, Dockery DW, Schwartz J, Zanobetti A (2000) The National Morbidity, Mortality, and Air Pollution Study. Part II: morbidity and mortality from air pollution in the United States. Res Rep Health Eff Inst 94(Pt 2):5–70 discussion 71–79

    CAS  Google Scholar 

  • Scarinzi C, Alessandrini ER, Chiusolo M, Galassi C, Baldini M, Serinelli M, Pandolfi P, Bruni A, Biggeri A, De Togni A, Carreras G, Casella C, Canova C, Randi G, Ranzi A, Morassuto C, Cernigliaro A, Giannini S, Lauriola P, Minichilli F, Gherardi B, Zauli-Sajani S, Stafoggia M, Casale P, Gianicolo EAL, Piovesan C, Tominz R, Porcaro L, Cadum E (2013) Inquinamento atmosferico e ricoveri ospedalieri urgenti in 25 città italiane: risultati del progetto Epi Air 2. Epidemiol Prev 2013 37(4–5):230–241

    Google Scholar 

  • Sen PK (1968) Estimates of regression coefficient based on Kendall’tau. J Am Stat Assoc 63(324):1379–1389

    Article  Google Scholar 

  • Sheahan P, Miller I, Sheahan JN, Earley MJ, Blayney AW (2003) Incidence and outcome of middle ear disease in cleft lip and/or cleft palate. Int J Pediatr Otorhinolaringol 67(7):785–793

    Article  Google Scholar 

  • Sprem N, Branica S (1993) Effect of climatic elements on the frequency of secretory otitis media. Eur Arch Oto-Rhino Laryngol 250(5):286–288

    Article  CAS  Google Scholar 

  • Stockmann C, Ampofo K, Hersh AL, Carleton ST, Korgenski K, Sheng X, Pavia AT, Byington CL (2013) Seasonality of acute otitis media and the role of respiratory viral activity in children. Pediatr Infect Dis J 32(4):314–319

    Article  Google Scholar 

  • Swarts JD, Alper CM, Luntz M, Bluestone CD, Doyle WJ, Ghadiali SN, Poe DS, Takahashi H, Tideholm B (2013) Panel 2: eustachian tube, middle ear, and mastoid–anatomy, physiology, pathophysiology, and pathogenesis. Otolaryngol Head Neck Surg 148(4_suppl):E26–E36

  • Takasaki K, Takahashi H, Miyamoto I, Yoshida H, Yamamoto-Fukuda T, Enatsu K, Kumagami H (2007) Measurement of angle and length of the eustachian tube on computed tomography using the multiplanar reconstruction technique. Laryngoscope 117(7):1251–4

  • Teele DW, Klein JO, Rosner B (1989) Epidemiology of otitis media during the first seven years of life in children in greater Boston: a prospective, cohort study. J Infect Dis 160(1):83–94

    Article  CAS  Google Scholar 

  • Theil H (1950) A rank invariant method of linear and polynomial regression analysis, i, ii, iii. Proceedings of the Koninklijke Nederlandse AkademieWetenshappen, Series A. Math Sci 53:386–392 521-525, 1397–1412

    Google Scholar 

  • Vakharia KT, Shapiro NL, Bhattacharyya N (2010) Demographic disparitiesamong children with frequent ear infections in the United States. Laryngoscope 120:1667–1670

    Article  Google Scholar 

  • Winther B, Alper CM, Mandel EM, Doyle WJ, Hendley JO (2007) Temporalrelationships between colds, upper respiratory viruses detectedby polymerase chain reaction, and otitis media in young children followedthrough a typical cold season. Pediatrics 119:1069–1075

    Article  Google Scholar 

  • Xu Z, Hu W, Su H, Turner LR, Ye X, Wang J, Tong S (2014) Extreme temperatures and paediatric emergency department admissions. J Epidemiol Community Health 68:304–311

    Article  Google Scholar 

  • Zemek R, Szyszkowicz M, Rowe MB (2010) Air pollution and emergency department visits for otitis media: a case-crossover study in Edmonton, Canada. Environ Health Perspect 118:1631–1636

    Article  Google Scholar 

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Acknowledgments

We wish to thank the S. Croce and Carle Hospital of Cuneo for the data, as well as Mrs. Olivia Cerrina and Mr. Mauro Giraudo for their valuable support throughout the research.

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Authors and Affiliations

  1. Department of Biomedical Science for Health, Centre for Research in Medical Bioclimatology, Thermal and Complementary Medicine, and Wellness Sciences, Milan State University, Via Cicognara, 7, 20129, Milan, Italy

    Massimo Gestro, Vincenzo Condemi & Umberto Solimene

  2. Cuneo Department, Environmental Protection Agency of Piedmont, Turin, Italy

    Luisella Bardi

  3. S. Croce and Carle Hospital of Cuneo, SOC ORL Unit, Cuneo, Italy

    Claudio Fantino

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  1. Massimo Gestro
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  2. Vincenzo Condemi
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Correspondence to Vincenzo Condemi.

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Gestro, M., Condemi, V., Bardi, L. et al. Meteorological factors, air pollutants, and emergency department visits for otitis media: a time series study. Int J Biometeorol 61, 1749–1764 (2017). https://doi.org/10.1007/s00484-017-1356-7

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