Date of Award

11-25-2008

Degree Type

Closed Thesis

Degree Name

Master of Public Health (MPH)

Department

Public Health

First Advisor

Frances McCarty, PhD - Co-Chair

Second Advisor

Derek Shendell, D.Env, MPH - Co-Chair

Third Advisor

Pamela Meyer, PhD

Abstract

BACKGROUND: A growing body of research has suggested that exposure to traffic-related emissions is associated with numerous adverse health effects including prevalence and severity of symptoms of asthma, hospitalizations for acute myocardial infarctions, and cardiovascular-related mortality. No previous studies have assessed the association between proximity to traffic and respiratory and cardiovascular outcomes across all age groups. OBJECTIVE: The purpose of this study was to assess the association between proximity to traffic emissions within the City of Atlanta and respiratory and cardiovascular 911 Emergency Management Service (EMS) calls and subsequent emergency department (ED) visits. METHODS: Case and control diagnostic groups were established for 5,450 EMS calls received between 2004 and 2008 from residents of the City of Atlanta based on ICD-9 codes assigned within the ED. Case diagnostic groups included asthma, cardiovascular outcomes, and stroke. Gastrointestinal diagnostic groups were selected as controls. Cumulative traffic within a 100 m buffer of the call origination location was used as an indicator of exposure to traffic emissions. Using a case-control study design, the associations between exposure to traffic emissions and the case diagnostic groups were evaluated using logistic regression, controlling for potential confounding factors including age, gender, ethnicity, and socio-economic status (SES). Subgroup analyses were performed to evaluate differences by select age categories, gender, and SES. P-values of <0.05 and 95% confidence intervals (CI) were used to determine statistical significance. RESULTS: Increased cumulative traffic near the call location was associated with an increase in the odds of an EMS call and ED visit for cardiovascular outcomes compared to the control diagnostic group even after adjustment for confounding factors (OR = 1.07; 95% CI ,1.01-1.12). The strongest effects were among men and individuals aged 40-75 years. Increased cumulative traffic was also associated with an increased odds of an EMS call and ED visit for stroke among individuals aged 18-39 years after adjusting for confounding (OR = 1.16; 95% CI, 1.01-1.34). No statistically significant associations were found between increased cumulative traffic and the odds of an EMS call and ED visit for asthma. CONCLUSION: These results provide additional evidence that proximity to traffic is associated with adverse cardiovascular outcomes and stroke in certain age groups.

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