Abstract
Introduction Poor air quality (AQ) is a global public health issue and AQ events can span across countries. Using emergency department (ED) syndromic surveillance from England and France, we describe changes in human health indicators during periods of particularly poor AQ in London and Paris during 2014. Methods Using daily AQ data for 2014, we identified three periods of poor AQ affecting both London and Paris. Anonymised near real-time ED attendance syndromic surveillance data from EDs across England and France were used to monitor the health impact of poor AQ. Using the routine English syndromic surveillance detection methods, increases in selected ED syndromic indicators (asthma, difficulty breathing and myocardial ischaemia), in total and by age, were identified and compared with periods of poor AQ in each city. Retrospective Wilcoxon-Mann-Whitney tests were used to identify significant increases in ED attendance data on days with (and up to 3 days following) poor AQ. Results Almost 1.5 million ED attendances were recorded during the study period (27 February 2014 to 1 October 2014). Significant increases in ED attendances for asthma were identified around periods of poor AQ in both cities, especially in children (aged 0-14 years). Some variation was seen in Paris with a rapid increase during the first AQ period in asthma attendances among children (aged 0-14 years), whereas during the second period the increase was greater in adults. Discussion This work demonstrates the public health value of syndromic surveillance during air pollution incidents. There is potential for further cross-border harmonisation to provide Europe-wide early alerting to health impacts and improve future public health messaging to healthcare services to provide warning of increases in demand.
| Original language | English |
|---|---|
| Article number | e018732 |
| Journal | BMJ Open |
| Volume | 8 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - 1 Apr 2018 |
Bibliographical note
Funding Information:1Real-time Syndromic Surveillance Team, National Infection Service, Public Health England, Birmingham, UK 2The Farr Institute, The Health eResearch Centre, University of Liverpool, Liverpool, UK 3Syndromic Surveillance Unit, Santé Publique France, The National Public Health Agency, Paris, France 4Environmental Hazards and Emergencies Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Birmingham, UK 5Emergency Department, John Radcliffe Hospital, Oxford, UK 6The Royal College of Emergency Medicine, London, UK Acknowledgements The authors acknowledge the contribution and support from the ED clinicians and Trust staff in the EDSSS; the ongoing support of the Royal College of Emergency Medicine; the technical support provided by EMIS Health and L2S2 Ltd in developing the EDSSS. The authors also acknowledge the contribution from the ED structures and clinicians involved in the OSCOUR network in France; the ongoing support of the Federation of the Regional Observatories of Emergencies; the Scientific Society of Emergency Medicine; the air and climate team of Santé publique France and the Regional Unit of Santé publique France in Paris-Ile-de-France region. The authors acknowledge and thank Sylvia Medina (Santé Publique France) for professional input and critical revision of this manuscript. HEH receives support from the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Gastrointestinal Infections. AJE and GES receive support from the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response.
Publisher Copyright:
© Crown copyright 2018. Reproduced with the permission of the Controller of Her Majesty's Stationery Office/Queen's Printer for Scotland and Public Health England.
Keywords
- air quality
- asthma
- emergency department
- particulate matter
- syndromic surveillance
