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a Department of Public Health
Sciences, St George's Hospital Medical School, London SW17 0RE, UK, b Air Quality Division, National
Environmental Technology Centre, AEA Technology, Harwell, Didcot,
Oxfordshire OX11 0RA, UK, c Pollen
Research Unit, Worcester College of Higher Education, Worcester WR2 6AJ
Correspondence to: Professor H R Anderson.
Received 9 January 1998; Returned to authors 5 March 1998; Revised version received 22 April 1998; Accepted for publication 15 May 1998
BACKGROUND
A study was undertaken to investigate
the relationship between daily hospital admissions for asthma and air
pollution in London in 1987-92 and the possible confounding and
modifying effects of airborne pollen.
METHODSFor all ages together and the age groups
0-14, 15-64 and 65+ years, Poisson regression was used to estimate
the relative risk of daily asthma admissions associated with changes in
ozone, sulphur dioxide, nitrogen dioxide and particles (black smoke),
controlling for time trends, seasonal factors, calendar effects,
influenza epidemics, temperature, humidity, and autocorrelation.
Independent effects of individual pollutants and interactions with
aeroallergens were explored using two pollutant models and models
including pollen counts (grass, oak and birch).
RESULTSIn all-year analyses ozone was
significantly associated with admissions in the 15-64 age group (10 ppb eight hour ozone, 3.93% increase), nitrogen dioxide in the 0-14
and 65+ age groups (10 ppb 24 hour nitrogen dioxide, 1.25% and
2.96%, respectively), sulphur dioxide in the 0-14 age group
(10 µg/m3 24 hour sulphur dioxide, 1.64%), and black
smoke in the 65+ age group (10 µg/m3 black smoke,
5.60%). Significant seasonal differences were observed for ozone in
the 0-14 and 15-64 age groups, and in the 0-14 age group there were
negative associations with ozone in the cool season. In general,
cumulative lags of up to three days tended to show stronger and more
significant effects than single day lags. In two-pollutant models these
associations were most robust for ozone and least for nitrogen dioxide.
There was no evidence that the associations with air pollutants were
due to confounding by any of the pollens, and little evidence of an
interaction between pollens and pollution except for synergism of
sulphur dioxide and grass pollen in children (p<0.01).
CONCLUSIONSOzone, sulphur dioxide, nitrogen
dioxide, and particles were all found to have significant associations
with daily hospital admissions for asthma, but there was a lack of
consistency across the age groups in the specific pollutant. These
associations were not explained by confounding by airborne pollens nor
was there convincing evidence that the effects of air pollutants and
airborne pollens interact in causing hospital admissions for asthma.
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