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

journal contribution
posted on 2023-05-18, 10:51 authored by Kaplan, GG, Tanyingoh, D, Dixon, E, Johnson, M, Amanda WheelerAmanda Wheeler, Myers, RP, Bertazzon, S, Saini, V, Madsen, K, Ghosh, S, Villeneuve, PJ

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.

History

Publication title

Environmental Health Perspectives

Volume

121

Issue

8

Pagination

939-943

ISSN

0091-6765

Department/School

Menzies Institute for Medical Research

Publisher

Us Dept Health Human Sciences Public Health Science

Place of publication

United States

Rights statement

Copyright unknown

Repository Status

  • Open

Socio-economic Objectives

Public health (excl. specific population health) not elsewhere classified

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