Air pollution, weather, and respiratory emergency room visits in two northern New England cities: an ecological time-series study

Daily emergency room (ER) visits for all respiratory (ICD-9 460-519) and asthma (ICD-9 493) were compared with daily sulfur dioxide (SO2), ozone (O3), and weather variables over the period 1998-2000 in Portland, Maine (population 248,000), and 1996-2000 in Manchester, New Hampshire (population 176,000). Seasonal variability was removed from all variables using nonparametric smoothed function (LOESS) of day of study. Generalized additive models were used to estimate the effect of elevated levels of pollutants on ER visits. Relative risks of pollutants are reported over their interquartile range (IQR, the 75th -25th percentile pollutant values). In Portland, an IQR increase in SO2 was associated with a 5% (95% CI 2-7%) increase in all respiratory ER visits and a 6% (95% CI 1-12%) increase in asthma visits. An IQR increase in O3 was associated with a 5% (95% CI 1-10%) increase in Portland asthmatic ER visits. No significant associations were found in Manchester, New Hampshire, possibly due to statistical limitations of analyzing a smaller population. The absence of statistical evidence for a relationship should not be used as evidence of no relationship. This analysis reveals that, on a daily basis, elevated SO2 and O3 have a significant impact on public health in Portland, Maine.