Ambient Air Quality and Fatal Asthma Exacerbations among Children in North Carolina

Abstract

Background: Little is known about the role of air quality in fatal asthma exacerbations among children. Methods: We collected information about 80 deaths that occurred in North Carolina from 2001 through 2016, among children aged 5–17 years, with asthma identified as the primary cause of death. We linked information about each death with county-level estimates of particulate matter ≤2.5 µm (PM2.5) and ozone (O3). Using the linked data, we conducted a case–crossover analysis of associations between PM2.5 and O3 lagged by 3–5 days with the odds of fatal asthma exacerbations. Results: In the highest tertile of PM2.5 lag(3–5), the odds of a fatal exacerbation of asthma were more than twice the odds in the lowest tertile (odds ratio = 2.2; 95% confidence interval = 1.1, 4.6). Conclusion: These findings from North Carolina provide evidence to support the hypothesis that ambient air pollution increases the risk of fatal exacerbations of asthma among children.