Pollen Exposure and Associated Healthcare Utilization: A Population-based Study Using Health Maintenance Organization Data in the Washington, DC, Area

Overview

Journal Ann Am Thorac Soc

Specialty Pulmonary Medicine

Date 2021 Apr 1

PMID 33794139

Citations 1

Authors

Douglas W Roblin

Jordan W Jones

Christina H Fuller

Affiliations

Soon will be listed here.

Abstract

Most studies of the healthcare utilization impact of pollen exposure have focused on emergency department visits or hospital admissions. However, other frequent but lower cost services-phone calls and e-mails to providers and office visits-may also be affected. The objective of our study was to estimate the impact of tree and grass pollen exposures on respiratory-related healthcare utilization across a range of medical services, including calls and e-mails to providers, nonurgent face-to-face visits, urgent and emergent care visits, and hospitalizations. We conducted a retrospective observational study of daily tree and grass pollen counts linked to electronic health records of Kaiser Permanente beneficiaries in the metropolitan Washington, DC, area for 2013-2014. The proportion of Kaiser Permanente beneficiaries with respiratory-related healthcare utilization was significantly greater (for ⩽ 0.05) given a 1 standard deviation increase in same-day pollen exposure. For tree pollen, a 1 standard deviation increase in same-day pollen exposure was associated with relative increases in utilization ranging from 1.77% (95% confidence interval [CI], 0.07-4.17%) for urgent and emergent care visits to 12.84% (95% CI, 11.02-14.65%) for provider calls/e-mails. For grass pollen exposure, a 1 standard deviation increase in same-day pollen exposure was associated with relative increases in utilization ranging from 1.42% (95% CI, 0.39-2.46) for provider face-to-face visits to 11.09% (95% CI, 9.26-12.92) for provider calls/e-mails. Increased pollen exposure was associated with increases in healthcare utilization across a range of services, with relatively higher increases in provider calls/e-mails and lower increases in emergent or acute care. If climate change increases intensity and geographic scope of pollen exposure as predicted and if this study's estimates of association of peak pollen exposure on healthcare utilization are generalizable, then the impact of climate change on healthcare utilization may be significant.

Citing Articles

Invasive Growth of Trees is Associated with a High Rate of Sensitization in Atopic Patients.

Prenzel F, Treudler R, Lipek T, Vom Hove M, Kage P, Kuhs S J Asthma Allergy. 2022; 15:1217-1226.

PMID: 36071746 PMC: 9443999. DOI: 10.2147/JAA.S373177.

References

Darrow L, Hess J, Rogers C, Tolbert P, Klein M, Sarnat S . Ambient pollen concentrations and emergency department visits for asthma and wheeze. J Allergy Clin Immunol. 2012; 130(3):630-638.e4. PMC: 3432157. DOI: 10.1016/j.jaci.2012.06.020. View

Zhang Y, Bielory L, Mi Z, Cai T, Robock A, Georgopoulos P . Allergenic pollen season variations in the past two decades under changing climate in the United States. Glob Chang Biol. 2014; 21(4):1581-9. PMC: 4356643. DOI: 10.1111/gcb.12755. View

May L, Carim M, Yadav K . Adult asthma exacerbations and environmental triggers: a retrospective review of ED visits using an electronic medical record. Am J Emerg Med. 2010; 29(9):1074-82. DOI: 10.1016/j.ajem.2010.06.034. View

Rice M, Thurston G, Balmes J, Pinkerton K . Climate change. A global threat to cardiopulmonary health. Am J Respir Crit Care Med. 2014; 189(5):512-9. PMC: 3977715. DOI: 10.1164/rccm.201310-1924PP. View

Zhong W, Levin L, Reponen T, Hershey G, Adhikari A, Shukla R . Analysis of short-term influences of ambient aeroallergens on pediatric asthma hospital visits. Sci Total Environ. 2006; 370(2-3):330-6. PMC: 2233936. DOI: 10.1016/j.scitotenv.2006.06.019. View

Lazarus R, Kleinman K, Dashevsky I, DeMaria A, Platt R . Using automated medical records for rapid identification of illness syndromes (syndromic surveillance): the example of lower respiratory infection. BMC Public Health. 2001; 1:9. PMC: 60002. DOI: 10.1186/1471-2458-1-9. View

Shaaban R, Zureik M, Soussan D, Neukirch C, Heinrich J, Sunyer J . Rhinitis and onset of asthma: a longitudinal population-based study. Lancet. 2008; 372(9643):1049-57. DOI: 10.1016/S0140-6736(08)61446-4. View

Heffernan R, Mostashari F, Das D, Besculides M, Rodriguez C, Greenko J . New York City syndromic surveillance systems. MMWR Suppl. 2005; 53:23-7. View

Meltzer E, Blaiss M, Derebery M, Mahr T, Gordon B, Sheth K . Burden of allergic rhinitis: results from the Pediatric Allergies in America survey. J Allergy Clin Immunol. 2009; 124(3 Suppl):S43-70. DOI: 10.1016/j.jaci.2009.05.013. View

10.

Burkom H, Ramac-Thomas L, Babin S, Holtry R, Mnatsakanyan Z, Yund C . An integrated approach for fusion of environmental and human health data for disease surveillance. Stat Med. 2011; 30(5):470-9. DOI: 10.1002/sim.3976. View

11.

Heguy L, Garneau M, Goldberg M, Raphoz M, Guay F, Valois M . Associations between grass and weed pollen and emergency department visits for asthma among children in Montreal. Environ Res. 2007; 106(2):203-11. DOI: 10.1016/j.envres.2007.10.005. View

12.

Moorman J, Akinbami L, Bailey C, Zahran H, King M, Johnson C . National surveillance of asthma: United States, 2001-2010. Vital Health Stat 3. 2013; (35):1-58. View

13.

Leynaert B, Neukirch C, Kony S, Guenegou A, Bousquet J, Aubier M . Association between asthma and rhinitis according to atopic sensitization in a population-based study. J Allergy Clin Immunol. 2004; 113(1):86-93. DOI: 10.1016/j.jaci.2003.10.010. View

14.

Sun X, Waller A, Yeatts K, Thie L . Pollen concentration and asthma exacerbations in Wake County, North Carolina, 2006-2012. Sci Total Environ. 2015; 544:185-91. DOI: 10.1016/j.scitotenv.2015.11.100. View

15.

Erbas B, Akram M, Dharmage S, Tham R, Dennekamp M, Newbigin E . The role of seasonal grass pollen on childhood asthma emergency department presentations. Clin Exp Allergy. 2012; 42(5):799-805. DOI: 10.1111/j.1365-2222.2012.03995.x. View

16.

DAmato G, Holgate S, Pawankar R, Ledford D, Cecchi L, Al-Ahmad M . Meteorological conditions, climate change, new emerging factors, and asthma and related allergic disorders. A statement of the World Allergy Organization. World Allergy Organ J. 2015; 8(1):25. PMC: 4499913. DOI: 10.1186/s40413-015-0073-0. View

17.

Fuller C, Roblin D, Jones J . Using Syndromic Surveillance to Evaluate the Respiratory Effects of Fine Particulate Matter. Ann Am Thorac Soc. 2019; 16(7):930-933. PMC: 6600839. DOI: 10.1513/AnnalsATS.201902-118RL. View

18.

Mazurek J, Syamlal G . Prevalence of Asthma, Asthma Attacks, and Emergency Department Visits for Asthma Among Working Adults - National Health Interview Survey, 2011-2016. MMWR Morb Mortal Wkly Rep. 2018; 67(13):377-386. PMC: 5889242. DOI: 10.15585/mmwr.mm6713a1. View

19.

Meltzer E, Blaiss M, Nathan R, Doherty D, Murphy K, Stoloff S . Asthma burden in the United States: results of the 2009 Asthma Insight and Management survey. Allergy Asthma Proc. 2012; 33(1):36-46. DOI: 10.2500/aap.2011.32.3519. View

20.

Westheimer E, Paladini M, Balter S, Weiss D, Fine A, Nguyen T . Evaluating the New York City Emergency Department Syndromic Surveillance for Monitoring Influenza Activity during the 2009-10 Influenza Season. PLoS Curr. 2012; 4:e500563f3ea181. PMC: 3441153. DOI: 10.1371/500563f3ea181. View