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Pediatric Psychiatric Emergency Department Utilization and Fine Particulate Matter: A Case-Crossover Study

Brokamp C, Strawn JR, Beck AF, Ryan P (2019) Environ Health Perspect.  2019 Sep;127(9): 97006. doi: 10.1289/EHP4815. Epub 2019 Sep 25. 

Web URL: Read this and related abstracts on PubMed here



Acute exposure to ambient particulate matter <2.5μm in aerodynamic diameter (PM2.5) has been associated with adult psychiatric exacerbations but has not been studied in children.


Our objectives were to estimate the association between acute exposures to ambient PM2.5 and psychiatric emergency department (ED) utilization and to determine if it is modified by community deprivation.


We used a time-stratified case-crossover design to analyze all pediatricpsychiatric ED encounters at Cincinnati Children's Hospital Medical Center in Cincinnati, Ohio, from 2011 to 2015 (n=13,176). Conditional logistic regression models adjusted for temperature, humidity, and holiday effects were used to estimate the odds ratio (OR) for a psychiatric ED visit 0-3 d after ambient PM2.5 exposures, estimated at residential addresses using a spatiotemporal model.


10-μg/m3 increase in PM2.5 was associated with a significant increase in any psychiatric ED utilization 1 [OR=1.07 (95% CI: 1.02, 1.12)] and 2 [OR=1.05 (95% CI: 1.00, 1.10)] d later. When stratified by visit reason, associations were significant for ED visits related to adjustment disorder {e.g., 1-d lag [OR=1.24 (95% CI: 1.02, 1.52)] and suicidality 1-d lag [OR=1.44 (95% CI: 1.03, 2.02)]}. There were significant differences according to community deprivation, with some lags showing stronger associations among children in high versus low deprivation areas for ED visits for anxiety {1-d lag [OR=1.39 (95% CI: 0.96, 2.01) vs. 0.85 (95% CI: 0.62, 1.17)] and suicidality same day [OR=1.98 (95% CI: 1.22, 3.23) vs. 0.93 (95% CI: 0.60, 1.45)]}. In contrast, for some lags, associations with ED visits for adjustment disorder were weaker for children in high-deprivation areas {1-d lag [OR=1.00 (95% CI: 0.76, 1.33) vs. 1.50 (95% CI: 1.16, 1.93)]}.


These findings warrant additional research to confirm the associations in other populations.


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