Particulate matter exposure predicts residence in high-risk areas for community acquired pneumonia among hospitalized children

Abstract

Particulate matter exposure is a risk factor for lower respiratory tract infection in children. Here, we investigated the geospatial patterns of community-acquired pneumonia and the impact of PM_2.5 (particulate matter with an aerodynamic diameter ≤2.5 µm) on geospatial variability of pneumonia in children. We performed a retrospective analysis of prospectively collected population-based surveillance study data of community-acquired pneumonia hospitalizations among children <18 years residing in the Memphis metropolitan area, who were enrolled in the Centers for Disease Control and Prevention sponsored Etiology of Pneumonia in the Community (EPIC) study from January 2010 to June 2012. The outcome measure, residence in high- and low-risk areas for community-acquired pneumonia, was determined by calculating pneumonia incidence rates and performing cluster analysis to identify areas with higher/lower than expected rates of community-acquired pneumonia for the population at risk. High PM_2.5 was defined as exposure to PM_2.5 concentrations greater than the mean value (>10.75 μg/m³), and low PM_2.5 is defined as exposure to PM_2.5 concentrations less than or equal to the mean value (≤10.75 μg/m³). We also assessed the effects of age, sex, race/ethnicity, history of wheezing, insurance type, tobacco smoke exposure, bacterial etiology, and viral etiology of infection. Of 810 (96.1%) subjects with radiographic community-acquired pneumonia, who resided in the Memphis metropolitan area and had addresses which were successfully geocoded (Supplementary Figure F2), 220 (27.2%) patients were identified to be from high- (n = 126) or low-risk (n = 94) community-acquired pneumonia areas. Community-acquired pneumonia in Memphis metropolitan area had a non-homogenous geospatial pattern. PM_2.5 was associated with residence in high-risk areas for community-acquired pneumonia. In addition, children with private insurance and bacterial, as opposed to viral, etiology of infection had a decreased risk of residence in a high-risk area for community-acquired pneumonia. The results from this paper suggest that environmental exposures as well as social risk factors are associated with childhood pneumonia.

Keywords: Pneumonia; high-risk areas; outcomes research; particulate matter; pediatrics; spatial patterns.

Figure 1.

Map showing location of study area including eight major regions of the Memphis Metropolitan Area, EPA monitoring sites, major roads, Superfund sites, and top PM_2.5 stationary emission sites based on tons of PM produced.

Figure 2.

Map showing, at census tract level, spatial clusters/hotspots and cold spots for community acquired pneumonia cases.