Air pollution and ED visits for asthma in Australian children: a case-crossover analysis

  • Bin JalaludinEmail author
  • Behnoosh Khalaj
  • Vicky Sheppeard
  • Geoff Morgan
Original Article



We aimed to determine the effects of ambient air pollutants on emergency department (ED) visits for asthma in children.


We obtained routinely collected ED visit data for asthma (ICD9 493) and air pollution (PM10, PM2.5, O3, NO2, CO and SO2) and meteorological data for metropolitan Sydney for 1997–2001. We used the time stratified case-crossover design and conditional logistic regression to model the association between air pollutants and ED visits for four age-groups (1–4, 5–9, 10–14 and 1–14 years). Estimated relative risks for asthma ED visits were calculated for an exposure corresponding to the inter-quartile range in pollutant level. We included same day average temperature, same day relative humidity, daily temperature range, school holidays and public holidays in all models.


Associations between ambient air pollutants and ED visits for asthma in children were most consistent for all six air pollutants in the 1–4 years age-group, for particulates and CO in the 5–9 years age-group and for CO in the 10–14 years age-group. The greatest effects were most consistently observed for lag 0 and effects were greater in the warm months for particulates, O3 and NO2. In two pollutant models, effect sizes were generally smaller compared to those derived from single pollutant models.


We observed the effects of ambient air pollutants on ED attendances for asthma in a city where the ambient concentrations of air pollutants are relatively low.


Ambient air pollution Asthma Case-crossover Children Emergency department visits 



We acknowledge the Australian Bureau of Meteorology for the meteorological data, and the NSW Department of Environment and Conservation for the air pollution data. We received funding from the Health Research Foundation Sydney South West, Sydney South West Area Health Service, and from the Environmental Health Branch, NSW Health Department. The use of de-identified, routinely collected data in this study did not require approval from an institutional human research ethics committee.

Conflict of interest

There is no conflict of interest.


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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Bin Jalaludin
    • 1
    • 2
    Email author
  • Behnoosh Khalaj
    • 3
  • Vicky Sheppeard
    • 3
  • Geoff Morgan
    • 4
    • 5
  1. 1.Centre for Research, Evidence Management and SurveillanceSydney South West Area Health ServiceLiverpoolAustralia
  2. 2.School of Public Health and Community MedicineUniversity of New South WalesSydneyAustralia
  3. 3.Environmental Health BranchNew South Wales Health DepartmentSydneyAustralia
  4. 4.Department of Rural Health (Northern Rivers)University of SydneySydneyAustralia
  5. 5.Division of Population Health and PlanningNorth Coast Area Health ServiceSydneyAustralia

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