1
|
Su JG, Barrett MA, Combs V, Henderson K, Van Sickle D, Hogg C, Simrall G, Moyer SS, Tarini P, Wojcik O, Sublett J, Smith T, Renda AM, Balmes J, Gondalia R, Kaye L, Jerrett M. Identifying impacts of air pollution on subacute asthma symptoms using digital medication sensors. Int J Epidemiol 2021; 51:213-224. [PMID: 34664072 DOI: 10.1093/ije/dyab187] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Objective tracking of asthma medication use and exposure in real-time and space has not been feasible previously. Exposure assessments have typically been tied to residential locations, which ignore exposure within patterns of daily activities. METHODS We investigated the associations of exposure to multiple air pollutants, derived from nearest air quality monitors, with space-time asthma rescue inhaler use captured by digital sensors, in Jefferson County, Kentucky. A generalized linear mixed model, capable of accounting for repeated measures, over-dispersion and excessive zeros, was used in our analysis. A secondary analysis was done through the random forest machine learning technique. RESULTS The 1039 participants enrolled were 63.4% female, 77.3% adult (>18) and 46.8% White. Digital sensors monitored the time and location of over 286 980 asthma rescue medication uses and associated air pollution exposures over 193 697 patient-days, creating a rich spatiotemporal dataset of over 10 905 240 data elements. In the generalized linear mixed model, an interquartile range (IQR) increase in pollutant exposure was associated with a mean rescue medication use increase per person per day of 0.201 [95% confidence interval (CI): 0.189-0.214], 0.153 (95% CI: 0.136-0.171), 0.131 (95% CI: 0.115-0.147) and 0.113 (95% CI: 0.097-0.129), for sulphur dioxide (SO2), nitrogen dioxide (NO2), fine particulate matter (PM2.5) and ozone (O3), respectively. Similar effect sizes were identified with the random forest model. Time-lagged exposure effects of 0-3 days were observed. CONCLUSIONS Daily exposure to multiple pollutants was associated with increases in daily asthma rescue medication use for same day and lagged exposures up to 3 days. Associations were consistent when evaluated with the random forest modelling approach.
Collapse
Affiliation(s)
- Jason G Su
- Division of Environmental Health Sciences, School of Public Health, University of California at Berkeley, Berkeley, CA, USA
| | | | - Veronica Combs
- Center for Healthy Air, Water and Soil, University of Louisville, Louisville, KY, USA
| | | | - David Van Sickle
- Propeller Health, Madison, WI, USA.,Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Chris Hogg
- Propeller Health, San Francisco, CA, USA
| | - Grace Simrall
- Louisville Metro, Office of Civic Innovation, Louisville, KY, USA
| | - Sarah S Moyer
- Louisville Metro, Department of Public Health and Wellness, Louisville, KY, USA
| | - Paul Tarini
- Robert Wood Johnson Foundation, Princeton, NJ, USA
| | | | | | - Ted Smith
- Center for Healthy Air, Water and Soil, University of Louisville, Louisville, KY, USA.,Envirome Institute, School of Medicine, University of Louisville, Louisville, KY, USA
| | | | - John Balmes
- Division of Environmental Health Sciences, School of Public Health, University of California at Berkeley, Berkeley, CA, USA
| | | | | | - Michael Jerrett
- Fielding School of Public Health, University of California, Los Angeles, CA, USA
| |
Collapse
|
2
|
Casey JA, Su JG, Henneman LR, Zigler C, Neophytou AM, Catalano R, Gondalia R, Chen YT, Kaye L, Moyer SS, Combs V, Simrall G, Smith T, Sublett J, Barrett MA. Improved asthma outcomes observed in the vicinity of coal power plant retirement, retrofit, and conversion to natural gas. Nat Energy 2020; 5:398-408. [PMID: 32483491 PMCID: PMC7263319 DOI: 10.1038/s41560-020-0600-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 03/06/2020] [Indexed: 05/25/2023]
Abstract
Coal-fired power plants release substantial air pollution, including over 60% of U.S. sulfur dioxide (SO2) emissions in 2014. Such air pollution may exacerbate asthma however direct studies of health impacts linked to power plant air pollution are rare. Here, we take advantage of a natural experiment in Louisville, Kentucky, where one coal-fired power plant retired and converted to natural gas, and three others installed SO2 emission control systems between 2013 and 2016. Dispersion modeling indicated exposure to SO2 emissions from these power plants decreased after the energy transitions. We used several analysis strategies, including difference-in-differences, first-difference, and interrupted time-series modeling to show that the emissions control installations and plant retirements were associated with reduced asthma disease burden related to ZIP code-level hospitalizations and emergency room visits, and individual-level medication use as measured by digital medication sensors.
Collapse
Affiliation(s)
- Joan A. Casey
- School of Public Health, University of California, Berkeley, California, USA 94720
- Columbia University Mailman School of Public Health, New York, New York, USA 10032
| | - Jason G. Su
- School of Public Health, University of California, Berkeley, California, USA 94720
| | - Lucas R.F. Henneman
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA 02115
| | - Corwin Zigler
- Department of Statistics and Data Sciences and Department of Women's Health, University of Texas, Austin, Texas, USA
| | - Andreas M. Neophytou
- School of Public Health, University of California, Berkeley, California, USA 94720
- Department of Environmental and Radiological Sciences, Colorado State University, Fort Collins, Colorado, USA 80523
| | - Ralph Catalano
- School of Public Health, University of California, Berkeley, California, USA 94720
| | | | - Yu-Ting Chen
- Louisville Metro Department of Public Health and Wellness, Louisville, Kentucky, USA 40202
| | - Leanne Kaye
- Propeller Health, San Francisco, California, USA 94108
| | - Sarah S. Moyer
- Louisville Metro Department of Public Health and Wellness, Louisville, Kentucky, USA 40202
| | - Veronica Combs
- Christina Lee Brown Environment Institute, University of Louisville, Louisville, Kentucky, USA 40202
| | - Grace Simrall
- Louisville Metro Office of Civic Innovation, Louisville, Kentucky, USA 40202
| | - Ted Smith
- Christina Lee Brown Environment Institute, University of Louisville, Louisville, Kentucky, USA 40202
| | - James Sublett
- Family Allergy & Asthma, Louisville, Kentucky, USA 40223
| | | |
Collapse
|