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Published ahead of print on October 1, 2009
Am. J. Respir. Crit. Care Med. 2009, doi:10.1164/rccm.200901-0160OC
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Submitted on January 31, 2009
Accepted on October 1, 2009

Long-term Exposure to Ambient Air Pollution and Risk of Hospitalization with Community-acquired Pneumonia in Older Adults

Binod Neupane1, Michael Jerrett2, Richard Burnett3, Thomas Marrie4, Altaf Arain5, and Mark Loeb6*

1 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada, 2 Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California, United States, 3 Environmental Health Directorate, Health Canada, Ottawa, Ontario, Canada, 4 Department of Medicine, University of Alberta, Edmonton, Canada, 5 School of Geography and Earth Sciences, McMaster University, Hamilton, Ontario, Canada, 6 Departments of Pathology and Molecular Medicine, Michael DeGroote Institute for Infectious Diseases, McMaster University, Hamilton, Ontario, Canada

* To whom correspondence should be addressed. E-mail: loebm{at}mcmaster.ca.

Objective: To assess the effect of long-term exposure to ambient nitrogen dioxide, sulphur dioxide and fine particulate matter with diameter equal to or smaller than 2.5μm (PM2.5) on hospitalization for community-acquired pneumonia in older adults. Methods: We used population-based case-control study in Hamilton, Ontario, Canada. We enrolled 345 hospitalized patients aged 65 years or more for community-acquired pneumonia and 494 control participants, aged 65 years and more randomly selected from the same community as cases from July 2003 to April 2005. Health data were collected by personal interview. Annual average levels of nitrogen dioxide, sulphur dioxide and PM2.5 prior to study period were estimated at the residential addresses of participants by inverse distance weighting, bi-cubic splined and land use regression methods and merged with participants’ health data. Main Results: Long-term exposure to higher levels of nitrogen dioxide and PM2.5 were significantly associated with hospitalization with community-acquired pneumonia (OR = 2.30, 95% CI 1.25 to 4.21, P = 0.007 and OR = 2.26, 95% CI 1.20 to 4.24, P = 0.012, respectively, over the 5-95 percentile range increase of exposure). Sulphur dioxide did not appear to have any association (OR = 0.97, 95% CI 0.59 to 1.61, P = 0.918). Results were somewhat sensitive to the choice of methods used to estimate air pollutant levels at residential addresses, although all risks from nitrogen dioxide and PM2.5 exposure were positive and generally significant. Conclusions: In older adults, exposure to ambient nitrogen dioxide and PM2.5 was associated with hospitalization for community-acquired pneumonia.


Key words: air pollution • case-control study • fine particulate matter • nitrogen dioxide • sulphur dioxide






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