Emergency Department Visits among Patients with Eosinophilic Esophagitis and Acute Exposures to Particulate Pollution (PM2.5)

摘要

Research suggests that environment plays a significant role in the presentation of eosinophilic esophagitis (EoE), an allergic disease affecting the esophagus, resulting in inflammation and esophageal symptoms. Aeroallergens are known to exacerbate EoE. Additional aeroantigens, such as air pollution, have been postulated to exacerbate EoE. We examined emergency department (ED) visits among EoE patients and acute exposures to ambient particulate air pollution (PM2.5). Retrospective case crossover analyses of ED visits among EoE patients (January 2000 - May 2014) were performed using data from the Utah Population Database, University of Utah Health Sciences Center, and Intermountain Healthcare and ambient air pollution data. Two separate methods were used to estimate PM2.5 exposure: 1) kriging of local monitoring stations and 2) assigning the observations from the closest monitor (limited to EoE patients living within a pre-specified distance to the closest monitor). We controlled for ozone, nitrogen dioxide, and temperature. The cohort included 4,381 EoE patients, 242 of whom had ED visits. The odds ratio (OR) of ED visit among EoE patients for chest pain, dysphagia, and/or esophageal impaction with PM2.5 above 35 μg/m3 on at least one day during the preceding week was 2.79, 95% confidence interval (CI) 1.04-7.46 using the kriging method for 131 ED visits that could be assigned PM2.5 data. Using the closest monitor estimation method, the OR was 2.96, 95% CI 1.07-8.25 for 76 ED visits that could be assigned PM2.5 data. Restricting the analysis to ED visits for dysphagia and/or impaction were significant for the kriging method, but not closest monitor. In this study using individual-level case-crossover analysis, we find evidence that acute exposures to PM2.5 is associated with exacerbations of EoE. Further research into the effects of air pollution on EoE is warranted, with careful consideration of the method used to assign pollution data to patient data.