Environmental factors associated with general practitioner consultations for allergic rhinitis in London, England: A retrospective time series analysis

Dan Todkill; Felipe De Jesus Colon Gonzalez; Roger Morbey; Andre Charlett; Shakoor Hajat; Sari Kovats; Nicholas J. Osborne; Rachel Mcinnes; Sotiris Vardoulakis; Karen Exley; Obaghe Edeghere; Gillian Smith; Alex Elliot

doi:10.1136/bmjopen-2019-036724

Environmental factors associated with general practitioner consultations for allergic rhinitis in London, England: A retrospective time series analysis

Dan Todkill^*, Felipe De Jesus Colon Gonzalez, Roger Morbey, Andre Charlett, Shakoor Hajat, Sari Kovats, Nicholas J. Osborne, Rachel Mcinnes, Sotiris Vardoulakis, Karen Exley, Obaghe Edeghere, Gillian Smith, Alex Elliot

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

8 Citations (Scopus)

Abstract

Objectives To identify key predictors of general practitioner (GP) consultations for allergic rhinitis (AR) using meteorological and environmental data. Design A retrospective, time series analysis of GP consultations for AR. Setting A large GP surveillance network of GP practices in the London area. Participants The study population was all persons who presented to general practices in London that report to the Public Health England GP in-hours syndromic surveillance system during the study period (3 April 2012 to 11 August 2014). Primary measure Consultations for AR (numbers of consultations). Results During the study period there were 186 401 GP consultations for AR. High grass and nettle pollen counts (combined) were associated with the highest increases in consultations (for the category 216-270 grains/m3, relative risk (RR) 3.33, 95% CI 2.69 to 4.12) followed by high tree (oak, birch and plane combined) pollen counts (for the category 260-325 grains/m3, RR 1.69, 95% CI 1.32 to 2.15) and average daily temperatures between 15°C and 20°C (RR 1.47, 95% CI 1.20 to 1.81). Higher levels of nitrogen dioxide (NO 2) appeared to be associated with increased consultations (for the category 70-85 μg/m3, RR 1.33, 95% CI 1.03 to 1.71), but a significant effect was not found with ozone. Higher daily rainfall was associated with fewer consultations (15-20 mm/day; RR 0.812, 95% CI 0.674 to 0.980). Conclusions Changes in grass, nettle or tree pollen counts, temperatures between 15°C and 20°C, and (to a lesser extent) NO 2 concentrations were found to be associated with increased consultations for AR. Rainfall has a negative effect. In the context of climate change and continued exposures to environmental air pollution, intelligent use of these data will aid targeting public health messages and plan healthcare demand.

Original language	English
Article number	e036724
Journal	BMJ Open
Volume	10
Issue number	12
DOIs	https://doi.org/10.1136/bmjopen-2019-036724
Publication status	Published - 4 Dec 2020

Bibliographical note

Funding Information:
Funding The research was funded through PHE core activities, and supported in part by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Environmental Change and Health (SH, SK, NJO, RMc) at the London School of Hygiene and Tropical Medicine in partnership with PHE, and in collaboration with the University of Exeter, University College London, and the Met Office. FdJCG, RMo, OE, GS and AJE were supported by the NIHR HPRU in Emergency Preparedness and Response at King’s College London in partnership with PHE. Funding for open access publication was through the NIHR HPRU in Environmental Change and Health. The views expressed are those of the authors not necessarily those of the NHS, the NIHR, the Department of Health and Social Care or Public Health England.

Publisher Copyright:
© Author(s) (or their employer(s)) 2020.

Keywords

allergy
epidemiology
primary care
public health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1136/bmjopen-2019-036724

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Todkill, D., De Jesus Colon Gonzalez, F., Morbey, R., Charlett, A., Hajat, S., Kovats, S., Osborne, N. J., Mcinnes, R., Vardoulakis, S., Exley, K., Edeghere, O., Smith, G., & Elliot, A. (2020). Environmental factors associated with general practitioner consultations for allergic rhinitis in London, England: A retrospective time series analysis. BMJ Open, 10(12), Article e036724. https://doi.org/10.1136/bmjopen-2019-036724

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title = "Environmental factors associated with general practitioner consultations for allergic rhinitis in London, England: A retrospective time series analysis",

abstract = "Objectives To identify key predictors of general practitioner (GP) consultations for allergic rhinitis (AR) using meteorological and environmental data. Design A retrospective, time series analysis of GP consultations for AR. Setting A large GP surveillance network of GP practices in the London area. Participants The study population was all persons who presented to general practices in London that report to the Public Health England GP in-hours syndromic surveillance system during the study period (3 April 2012 to 11 August 2014). Primary measure Consultations for AR (numbers of consultations). Results During the study period there were 186 401 GP consultations for AR. High grass and nettle pollen counts (combined) were associated with the highest increases in consultations (for the category 216-270 grains/m3, relative risk (RR) 3.33, 95% CI 2.69 to 4.12) followed by high tree (oak, birch and plane combined) pollen counts (for the category 260-325 grains/m3, RR 1.69, 95% CI 1.32 to 2.15) and average daily temperatures between 15°C and 20°C (RR 1.47, 95% CI 1.20 to 1.81). Higher levels of nitrogen dioxide (NO 2) appeared to be associated with increased consultations (for the category 70-85 μg/m3, RR 1.33, 95% CI 1.03 to 1.71), but a significant effect was not found with ozone. Higher daily rainfall was associated with fewer consultations (15-20 mm/day; RR 0.812, 95% CI 0.674 to 0.980). Conclusions Changes in grass, nettle or tree pollen counts, temperatures between 15°C and 20°C, and (to a lesser extent) NO 2 concentrations were found to be associated with increased consultations for AR. Rainfall has a negative effect. In the context of climate change and continued exposures to environmental air pollution, intelligent use of these data will aid targeting public health messages and plan healthcare demand.",

keywords = "allergy, epidemiology, primary care, public health",

author = "Dan Todkill and {De Jesus Colon Gonzalez}, Felipe and Roger Morbey and Andre Charlett and Shakoor Hajat and Sari Kovats and Osborne, {Nicholas J.} and Rachel Mcinnes and Sotiris Vardoulakis and Karen Exley and Obaghe Edeghere and Gillian Smith and Alex Elliot",

note = "Funding Information: Funding The research was funded through PHE core activities, and supported in part by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Environmental Change and Health (SH, SK, NJO, RMc) at the London School of Hygiene and Tropical Medicine in partnership with PHE, and in collaboration with the University of Exeter, University College London, and the Met Office. FdJCG, RMo, OE, GS and AJE were supported by the NIHR HPRU in Emergency Preparedness and Response at King{\textquoteright}s College London in partnership with PHE. Funding for open access publication was through the NIHR HPRU in Environmental Change and Health. The views expressed are those of the authors not necessarily those of the NHS, the NIHR, the Department of Health and Social Care or Public Health England. Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2020.",

year = "2020",

month = dec,

day = "4",

doi = "10.1136/bmjopen-2019-036724",

language = "English",

volume = "10",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

number = "12",

}

Todkill, D, De Jesus Colon Gonzalez, F, Morbey, R , Charlett, A, Hajat, S, Kovats, S, Osborne, NJ, Mcinnes, R, Vardoulakis, S, Exley, K , Edeghere, O , Smith, G & Elliot, A 2020, 'Environmental factors associated with general practitioner consultations for allergic rhinitis in London, England: A retrospective time series analysis', BMJ Open, vol. 10, no. 12, e036724. https://doi.org/10.1136/bmjopen-2019-036724

TY - JOUR

T1 - Environmental factors associated with general practitioner consultations for allergic rhinitis in London, England

T2 - A retrospective time series analysis

AU - Todkill, Dan

AU - De Jesus Colon Gonzalez, Felipe

AU - Morbey, Roger

AU - Charlett, Andre

AU - Hajat, Shakoor

AU - Kovats, Sari

AU - Osborne, Nicholas J.

AU - Mcinnes, Rachel

AU - Vardoulakis, Sotiris

AU - Exley, Karen

AU - Edeghere, Obaghe

AU - Smith, Gillian

AU - Elliot, Alex

N1 - Funding Information: Funding The research was funded through PHE core activities, and supported in part by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Environmental Change and Health (SH, SK, NJO, RMc) at the London School of Hygiene and Tropical Medicine in partnership with PHE, and in collaboration with the University of Exeter, University College London, and the Met Office. FdJCG, RMo, OE, GS and AJE were supported by the NIHR HPRU in Emergency Preparedness and Response at King’s College London in partnership with PHE. Funding for open access publication was through the NIHR HPRU in Environmental Change and Health. The views expressed are those of the authors not necessarily those of the NHS, the NIHR, the Department of Health and Social Care or Public Health England. Publisher Copyright: © Author(s) (or their employer(s)) 2020.

PY - 2020/12/4

Y1 - 2020/12/4

N2 - Objectives To identify key predictors of general practitioner (GP) consultations for allergic rhinitis (AR) using meteorological and environmental data. Design A retrospective, time series analysis of GP consultations for AR. Setting A large GP surveillance network of GP practices in the London area. Participants The study population was all persons who presented to general practices in London that report to the Public Health England GP in-hours syndromic surveillance system during the study period (3 April 2012 to 11 August 2014). Primary measure Consultations for AR (numbers of consultations). Results During the study period there were 186 401 GP consultations for AR. High grass and nettle pollen counts (combined) were associated with the highest increases in consultations (for the category 216-270 grains/m3, relative risk (RR) 3.33, 95% CI 2.69 to 4.12) followed by high tree (oak, birch and plane combined) pollen counts (for the category 260-325 grains/m3, RR 1.69, 95% CI 1.32 to 2.15) and average daily temperatures between 15°C and 20°C (RR 1.47, 95% CI 1.20 to 1.81). Higher levels of nitrogen dioxide (NO 2) appeared to be associated with increased consultations (for the category 70-85 μg/m3, RR 1.33, 95% CI 1.03 to 1.71), but a significant effect was not found with ozone. Higher daily rainfall was associated with fewer consultations (15-20 mm/day; RR 0.812, 95% CI 0.674 to 0.980). Conclusions Changes in grass, nettle or tree pollen counts, temperatures between 15°C and 20°C, and (to a lesser extent) NO 2 concentrations were found to be associated with increased consultations for AR. Rainfall has a negative effect. In the context of climate change and continued exposures to environmental air pollution, intelligent use of these data will aid targeting public health messages and plan healthcare demand.

AB - Objectives To identify key predictors of general practitioner (GP) consultations for allergic rhinitis (AR) using meteorological and environmental data. Design A retrospective, time series analysis of GP consultations for AR. Setting A large GP surveillance network of GP practices in the London area. Participants The study population was all persons who presented to general practices in London that report to the Public Health England GP in-hours syndromic surveillance system during the study period (3 April 2012 to 11 August 2014). Primary measure Consultations for AR (numbers of consultations). Results During the study period there were 186 401 GP consultations for AR. High grass and nettle pollen counts (combined) were associated with the highest increases in consultations (for the category 216-270 grains/m3, relative risk (RR) 3.33, 95% CI 2.69 to 4.12) followed by high tree (oak, birch and plane combined) pollen counts (for the category 260-325 grains/m3, RR 1.69, 95% CI 1.32 to 2.15) and average daily temperatures between 15°C and 20°C (RR 1.47, 95% CI 1.20 to 1.81). Higher levels of nitrogen dioxide (NO 2) appeared to be associated with increased consultations (for the category 70-85 μg/m3, RR 1.33, 95% CI 1.03 to 1.71), but a significant effect was not found with ozone. Higher daily rainfall was associated with fewer consultations (15-20 mm/day; RR 0.812, 95% CI 0.674 to 0.980). Conclusions Changes in grass, nettle or tree pollen counts, temperatures between 15°C and 20°C, and (to a lesser extent) NO 2 concentrations were found to be associated with increased consultations for AR. Rainfall has a negative effect. In the context of climate change and continued exposures to environmental air pollution, intelligent use of these data will aid targeting public health messages and plan healthcare demand.

KW - allergy

KW - epidemiology

KW - primary care

KW - public health

UR - http://www.scopus.com/inward/record.url?scp=85097310734&partnerID=8YFLogxK

U2 - 10.1136/bmjopen-2019-036724

DO - 10.1136/bmjopen-2019-036724

M3 - Article

C2 - 33277274

AN - SCOPUS:85097310734

SN - 2044-6055

VL - 10

JO - BMJ Open

JF - BMJ Open

IS - 12

M1 - e036724

ER -

Environmental factors associated with general practitioner consultations for allergic rhinitis in London, England: A retrospective time series analysis

Abstract

Bibliographical note

Keywords

UN SDGs

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