An examination of exposure measurement error from air pollutant spatial variability in time-series studies.

Relatively few studies have evaluated the effects of heterogeneous spatiotemporal pollutant distributions on health risk estimates in time-series analyses that use data from a central monitor to assign exposures. We present a method for examining the effects of exposure measurement error relating to spatiotemporal variability in ambient air pollutant concentrations on air pollution health risk estimates in a daily time-series analysis of emergency department visits in Atlanta, Georgia. We used Poisson generalized linear models to estimate associations between current-day pollutant concentrations and circulatory emergency department visits for the 1998-2004 time period. Data from monitoring sites located in different geographical regions of the study area and at different distances from several urban geographical subpopulations served as alternative measures of exposure. We observed associations for spatially heterogeneous pollutants (CO and NO(2)) using data from several different urban monitoring sites. These associations were not observed when using data from the most rural site, located 38 miles from the city center. In contrast, associations for spatially homogeneous pollutants (O(3) and PM(2.5)) were similar, regardless of the monitoring site location. We found that monitoring site location and the distance of a monitoring site to a population of interest did not meaningfully affect estimated associations for any pollutant when using data from urban sites located within 20 miles from the population center under study. However, for CO and NO(2), these factors were important when using data from rural sites located > or = 30 miles from the population center, most likely owing to exposure measurement error. Overall, our findings lend support to the use of pollutant data from urban central sites to assess population exposures within geographically dispersed study populations in Atlanta and similar cities.