The Association between Respiratory Infection and Air Pollution in the Setting of Air Quality Policy and Economic Change

Rationale: Fine particulate matter air pollution of 2.5 μm or less in diameter (PM2.5) has been associated with an increased risk of respiratory disease, but assessments of specific respiratory infections in adults are lacking.Objectives: To estimate the rate of respiratory infection healthcare encounters in adults associated with acute increases in PM2.5 concentrations.Methods: Using case–crossover methods, we studied 498,118 adult New York State residents with a primary diagnosis of influenza, bacterial pneumonia, or culture-negative pneumonia upon hospitalization or emergency department (ED) visit (2005–2016). We estimated the relative rate of healthcare encounters associated with increases in PM2.5 in the previous 1–7 days and explored differences before (2005–2007), during (2008–2013), and after (2014–2016) implementation of air quality policies and economic changes.Results: Interquartile range increases in PM2.5 over the previous 7 days were associated with increased excess rates (ERs) of culture-ne...