Meteorological factors, air pollutants, and emergency department visits for otitis media: a time series study.

AbstractOtitis media (OM) is a very common disease in children, which results in a significant economic burden to the healthcare system for hospital-based outpatient departments, emergency departments (EDs), unscheduled medical examinations, and antibiotic prescriptions. The aim of this retrospective observational study is to investigate the association between climate variables, air pollutants, and OM visits observed in the 2007-2010 period at the ED of Cuneo, Italy. Measures of meteorological parameters (temperature, humidity, atmospheric pressure, wind) and outdoor air pollutants (particulate matter, ozone, nitrous dioxide) were analyzed at two statistical stages and in several specific steps (crude and adjusted models) according to Poisson's regression. Response variables included daily examinations for age groups 0-3, 0-6, and 0-18. Control variables included upper respiratory infections (URI), flu (FLU), and several calendar factors. A statistical procedure was implemented to capture any delayed effects. Results show a moderate association for temperature (T), age 0-3, and 0-6 with P < 0.05, as well as nitrous dioxide (NO2) with P < 0.005 at age 0-18. Results of subsequent models point out to URI as an important control variable. No statistical association was observed for other pollutants and meteorological variables. The dose-response models (DLNM-final stage) implemented separately on a daily and hourly basis point out to an association between temperature (daily model) and RR 1.44 at age 0-3, CI 1.11-1.88 (lag time 0-1 days) and RR 1.43, CI 1.05-1.94 (lag time 0-3 days). The hourly model confirms a specific dose-response effect for T with RR 1.20, CI 1.04-1.38 (lag time range from 0 to 11 to 0-15 h) and for NO2 with RR 1.03, CI 1.01-1.05 (lag time range from 0 to 8 to 0-15 h). These results support the hypothesis that the clinical context of URI may be an important risk factor in the onset of OM diagnosed at ED level. The study highlights the relevance of URI as a control variable to be included in the statistical analysis in association with meteorological factors and air pollutants. The study also points out to a moderate association of OM with low temperatures and NO2, with specific risk factors for this variable early in life. Further studies are needed to confirm these findings, particularly with respect to air pollutants in larger urban environments.