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]
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 Type:||Refereed Article|
|Keywords:||air quality, health, appendicitis|
|Research Division:||Medical and Health Sciences|
|Research Group:||Public Health and Health Services|
|Research Field:||Environmental and Occupational Health and Safety|
|Objective Group:||Public Health (excl. Specific Population Health)|
|Objective Field:||Environmental Health|
|Author:||Wheeler, AJ (Dr Amanda Wheeler)|
|Web of Science® Times Cited:||16|
|Deposited By:||Menzies Institute for Medical Research|
|Downloads:||234 View Download Statistics|
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