Nitrogen dioxide and asthma emergency department visits in California, USA during cold season (November to February) of 2005 to 2015: A time-stratified case-crossover analysis

Nitrogen dioxide (NO2) is responsible for aggravating respiratory diseases, particularly asthma. The aim of this study is to investigate the association between NO2 exposure and asthma emergency department (ED) visits during the cold season (November–February) in five populated locations (Sacramento, San Francisco, Fresno, Los Angeles, and San Diego) of California from 2005 to 2015 (1320 Days). Conditional logistic regression models were used to obtain the odds ratio (OR) and 95% confidence interval (CI) associated with a 5 ppb increase in NO2 concentration for the 19,735 ED visits identified. An increase in NO2 exposure increased the odds of having asthma ED visits for the studied population. The potential effect modification by sex (female and male), race (White, Black, Hispanic, and Asian), and age (2–5, 6–18, 19–40, 41–64, and ≥65) was explored. A 5 ppb increase in the concentration of NO2 during lag 0–30 was associated with a 56% increase in the odds of having an asthma ED visit (OR = 1.560, CI: 1.428–1.703). Sex was not found to be a modifier. Asthma ED visits among all the races/ethnicities (except Asians) were associated with NO2 exposure. Whites had the highest OR 75% (OR = 1.750, CI: 1.417–2.160) at lag 0–30 in response to NO2 exposure. The association between NO2 exposure and asthma ED visits was positive among all age groups except for 19 to 40 years old; the OR was higher among 2 to 18 year old (at lag 0–30: age group 2–5 (OR = 1.699, CI: 1.399–2.062), and age group 6–18 (OR = 1.568, CI 1.348–1.825)). For stratification by location, San Diego and Fresno were found to have the highest OR, compared to the other studied locations. [Display omitted] •Effect of NO2 exposure on asthma emergency department (ED) visits was evaluated.•A time-stratified case-crossover method was used to address NO2 exposure.•Increase in NO2 concentration increases the odds of having asthma attack.•Among all races, Whites showed a greater association with NO2 exposure.•2 to 18 years old had the greater and faster response to NO2 exposure.