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Ambient Ozone Concentrations and the Risk of Perforated and Nonperforated Appendicitis: A Multicity Case-Crossover Study


Kaplan, GG and Tanyingoh, D and Dixon, E and Johnson, M and Wheeler, AJ and Myers, RP and Bertazzon, S and Saini, V and Madsen, K and Ghosh, S and Villeneuve, PJ, Ambient Ozone Concentrations and the Risk of Perforated and Nonperforated Appendicitis: A Multicity Case-Crossover Study, Environmental Health Perspectives, 121, (8) pp. 939-943. ISSN 0091-6765 (2013) [Refereed Article]



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DOI: doi:10.1289/ehp.1206085


Background: Environmental determinants of appendicitis are poorly understood. Past work suggests that air pollution may increase the risk of appendicitis.

Objectives: We investigated whether ambient ground-level ozone (O3) concentrations were associated with appendicitis and whether these associations varied between perforated and nonperforated appendicitis.

Methods: We based this time-stratified case-crossover study on 35,811 patients hospitalized with appendicitis from 2004 to 2008 in 12 Canadian cities. Data from a national network of fixed-site monitors were used to calculate daily maximum O3 concentrations for each city. Conditional logistic regression was used to estimate city-specific odds ratios (ORs) relative to an interquartile range (IQR) increase in O3 adjusted for temperature and relative humidity. A random-effects metaanalysis was used to derive a pooled risk estimate. Stratified analyses were used to estimate associations separately for perforated and nonperforated appendicitis.

Results: Overall, a 16-ppb increase in the 7-day cumulative average daily maximum O3 concentration was associated with all appendicitis cases across the 12 cities (pooled OR = 1.07; 95% CI: 1.02, 1.13). The association was stronger among patients presenting with perforated appendicitis for the 7-day average (pooled OR = 1.22; 95% CI: 1.09, 1.36) when compared with the corresponding estimate for nonperforated appendicitis [7-day average (pooled OR = 1.02, 95% CI: 0.95, 1.09)]. Heterogeneity was not statistically significant across cities for either perforated or nonperforated appendicitis (p > 0.20).

Conclusions: Higher levels of ambient O3 exposure may increase the risk of perforated appendicitis.

Item Details

Item Type:Refereed Article
Keywords:air quality, health, appendicitis
Research Division:Commerce, Management, Tourism and Services
Research Group:Human resources and industrial relations
Research Field:Occupational and workplace health and safety
Objective Division:Health
Objective Group:Public health (excl. specific population health)
Objective Field:Public health (excl. specific population health) not elsewhere classified
UTAS Author:Wheeler, AJ (Dr Amanda Wheeler)
ID Code:101131
Year Published:2013
Web of Science® Times Cited:37
Deposited By:Menzies Institute for Medical Research
Deposited On:2015-06-10
Last Modified:2017-11-03
Downloads:358 View Download Statistics

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