Air Quality Index as a Predictor of Respiratory Morbidity in At-Risk Populations
Abstract
1. Introduction
2. Methods
Statistical Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
AQI | Air Quality Index |
ED | Emergency Department |
PM2.5 | Particulate matter less than 2.5 μm in diameter |
PM10 | Particulate matter less than 10 μm in diameter |
SO2 | Sulfur dioxide |
SES | Socioeconomic status |
COPD | Chronic obstructive pulmonary disorder |
IRB | Institutional review board |
AHN | Allegheny Health Network |
ACS | American Community Survey |
EPA | Environmental Protection Agency |
Appendix A
Zip Codes | City Name | Number of Residents Living Within Zip Code |
---|---|---|
15025 | Jefferson Hills | 10,619 |
15034 | Dravosburg | 1612 |
15037 | Elizabeth | 13,271 |
15045 | Glassport | 4475 |
15104 | Braddock | 1721 |
15110 | Duquesne | 5254 |
15112 | West Mifflin | 19,589 |
15132 | McKeesport | 17,727 |
15133 | McKeesport | 6144 |
15137 | North Versailles | 10,079 |
15218 | Pittsburgh | 13,497 |
Date | AQI Responsible Pollutant(s) (AQI > 100) | Lawrenceville Ozone (ppm) 8 h | Liberty PM2.5 (μg/m3) 24 h Ave. | Liberty SO2 (ppb) Max 1 h | N. Braddock SO2 (ppb) Max 1 h | Lawrenceville NO2 (ppb) Max 1 h | Parkway E. NO2 (ppb) Max 1 h |
---|---|---|---|---|---|---|---|
03-Jan-2018 | PM2.5 Liberty | 0.023 | 47.458 | 32 | 12 | 35 | 37.1 |
19-Jan-2018 | SO2 Liberty | 0.033 | 18.417 | 130 | 5 | 19 | 13.4 |
10-Feb-2018 | SO2 N. Braddock | 31.208 | 68 | 91 | 28 | 34.1 | |
18-Mar-2018 | PM2.5 Liberty | 0.040 | 37.391 | 62 | 7 | 34 | 43.7 |
12-Apr-2018 | SO2 N. Braddock | 20.458 | 34 | 84 | 26 | 25.5 | |
13-Apr-2018 | SO2 N. Braddock | 0.060 | 27.667 | 50 | 113 | 16 | 20.9 |
01-May-2018 | PM2.5 Liberty | 0.067 | 38.000 | 65 | 62 | 26 | 38.1 |
02-May-2018 | SO2 Liberty | 0.059 | 35.000 | 76 | 50 | 22 | 36.8 |
04-May-2018 | SO2 Liberty | 0.051 | 12.350 | 155 | 2 | 15 | 17.6 |
09-May-2018 | SO2 Liberty | 0.062 | 19.958 | 144 | 30 | 20 | 21.8 |
12-May-2018 | SO2 Liberty | 0.053 | 21.875 | 122 | 18 | 8 | 15.4 |
26-May-2018 | Ozone | 0.072 | 27.045 | 34 | 2 | 20 | 19.1 |
28-May-2018 | Ozone | 0.076 | 24.292 | 36 | 7 | 13 | 16.6 |
08-Jun-2018 | Ozone | 0.076 | 26.708 | 24 | 13 | 15 | 25.1 |
29-Jun-2018 | Ozone | 0.074 | 30.375 | 43 | 15 | 16 | 20.0 |
30-Jun-2018 | Ozone | 0.079 | 27.273 | 0 | 5 | 8 | 24.6 |
10-Jul-2018 | Ozone | 0.073 | 25.739 | 50 | 16 | 11 | 29.0 |
01-Aug-2018 | SO2 Liberty | 0.043 | 13.917 | 79 | 3 | 13 | 17.0 |
13-Dec-2018 | PM2.5 Liberty | 0.019 | 42.875 | 70 | 51 | 32 | 33.3 |
26-Dec-2018 | PM2.5 Liberty & SO2 Liberty | 0.026 | 39.833 | 80 | 8 | 28 | 36.2 |
28-Dec-2018 | SO2 Liberty | 0.023 | 19.913 | 145 | 2 | 21 | |
02-Jan-2019 | SO2 Liberty | 0.018 | 11.625 | 81 | 8 | 13 | 16.0 |
03-Jan-2019 | SO2 Liberty | 0.019 | 11.478 | 85 | 9 | 20 | 15.6 |
07-Jan-2019 | SO2 N. Braddock | 0.024 | 7.458 | 17 | 83 | 23 | 13.2 |
08-Jan-2019 | SO2 Liberty | 0.033 | 26.091 | 80 | 34 | 16 | 15.0 |
02-Feb-2019 | PM2.5 Liberty | 0.027 | 69.625 | 64 | 10 | 33 | 32.8 |
03-Feb-2019 | PM2.5 Liberty | 0.025 | 75.750 | 61 | 41 | 33 | 32.8 |
04-Feb-2019 | PM2.5 Liberty | 0.039 | 74.625 | 52 | 82 | 41 | 38.3 |
24-Mar-2019 | PM2.5 Liberty | 0.046 | 38.292 | 54 | 29 | 27 | 34.9 |
28-Mar-2019 | PM2.5 Liberty & SO2 Liberty | 0.051 | 35.583 | 82 | 21 | 27 | 29.5 |
21-Dec-2019 | PM2.5 Liberty | 0.007 | 41.292 | 45 | 15 | 32 | 35.3 |
22-Dec-2019 | PM2.5 Liberty | 0.020 | 49.708 | 42 | 20 | 28 | 35.9 |
23-Dec-2019 | PM2.5 Liberty | 0.006 | 57.000 | 45 | 31 | 45 | 36.5 |
24-Dec-2019 | PM2.5 Liberty | 0.012 | 52.750 | 31 | 2 | 22 | 34.6 |
25-Dec-2019 | PM2.5 Liberty | 0.002 | 37.792 | 62 | 38 | 23 | 29.5 |
26-Dec-2019 | PM2.5 Liberty | 0.010 | 45.083 | 71 | 20 | 32 | 29.8 |
23-Feb-2020 | PM2.5 Liberty | 0.042 | 36.125 | 44 | 38 | 30 | 31.2 |
Days | Daily Exacerbation Rate Ratios (95% CI) | |||
---|---|---|---|---|
AQI | N | Asthma | COPD | Bronchitis |
Overall | RR (95% CI) | RR (95% CI) | RR (95% CI) | |
Good | 416 | ---- | ---- | ---- |
Moderate | 337 | 0.97 (0.83, 1.13) | 1.09 (0.94, 1.27) | 1.08 (0.89, 1.31) |
Unhealthy | 37 | 1.40 (1.02, 1.91) * | 0.99 (0.68, 1.43) | 1.05 (0.66, 1.65) |
Ozone | ||||
Good | 686 | ---- | ---- | ---- |
Moderate | 69 | 1.01 (0.77, 1.31) | 1.15 (0.90, 1.48) | 0.87 (0.61, 1.24) |
Unhealthy | 6 | 0.58 (0.19, 1.80) | 0.95 (0.39, 2.29) | 0.91 (0.29, 2.83) |
PM2.5 | ||||
Good | 443 | ---- | ---- | ---- |
Moderate | 330 | 1.03 (0.88, 1.20) | 1.09 (0.93, 1.26) | 1.00 (0.83, 1.22) |
Unhealthy | 17 | 1.62 (1.07, 2.48) * | 0.97 (0.57, 1.65) | 0.77 (0.36, 1.63) |
SO2 | ||||
Good | 693 | ---- | ---- | ---- |
Moderate | 80 | 0.99 (0.77, 1.28) | 1.16 (0.92, 1.46) | 1.04 (0.76, 1.42) |
Unhealthy | 17 | 1.60 (1.06, 2.43) * | 1.16 (0.71, 1.87) | 1.33 (0.75, 2.37) |
NO2 | ||||
Good | 790 | ---- | ---- | ---- |
Moderate | 0 | |||
Unhealthy | 0 |
Days | Daily Exacerbation Rate Ratios (95% CI) | |||
---|---|---|---|---|
AQI | N | Asthma | COPD | Bronchitis |
Overall | RR (95% CI) | RR (95% CI) | RR (95% CI) | |
Good | 416 | ---- | ---- | ---- |
Moderate | 337 | 0.72 (0.45, 1.13) | 0.82 (0.37, 1.83) | |
Unhealthy | 37 | 2.02 (1.00, 4.11) ~ | 0.75 (0.10, 5.67) | |
Ozone | ||||
Good | 686 | ---- | ---- | ---- |
Moderate | 69 | 0.90 (0.59, 1.37) | 0.40 (0.05, 2.94) | |
Unhealthy | 6 | 0.44 (0.11, 1.81) | No events | |
PM2.5 | ||||
Good | 443 | ---- | ---- | ---- |
Moderate | 330 | 0.79 (0.50, 1.22) | 0.90 (0.40, 1.99) | |
Unhealthy | 17 | 1.97 (0.71, 5.43) | 1.74 (0.23, 13.15) | |
SO2 | ||||
Good | 693 | ---- | ---- | ---- |
Moderate | 80 | 0.94 (0.45, 1.94) | 1.58 (0.54, 4.57) | |
Unhealthy | 17 | 3.31 (1.44, 7.60) * | No events | |
NO2 | ||||
Good | 790 | ---- | ---- | ---- |
Moderate | 0 | |||
Unhealthy | 0 |
Days | Daily Exacerbation Rate Ratios (95% CI) | |||
---|---|---|---|---|
AQI | N | Asthma | COPD | Bronchitis |
Overall | RR (95% CI) | RR (95% CI) | RR (95% CI) | |
Good | 416 | ---- | ---- | ---- |
Moderate | 337 | 1.03 (0.86, 1.24) | 1.15 (0.90, 1.47) | 1.13 (0.88, 1.46) |
Unhealthy | 37 | 1.47 (1.02, 2.11) * | 1.03 (0.57, 1.86) | 1.28 (0.74, 2.22) |
Ozone | ||||
Good | 686 | ---- | ---- | ---- |
Moderate | 69 | 1.00 (0.73, 1.38) | 1.40 (0.96, 2.02) ~ | 1.05 (0.68, 1.61) |
Unhealthy | 6 | 0.52 (0.13, 2.10) | 1.00 (0.25, 4.04) | 0.52 (0.07, 3.74) |
PM2.5 | ||||
Good | 443 | ---- | ---- | ---- |
Moderate | 330 | 1.11 (0.93, 1.33) | 1.07 (0.84, 1.37) | 1.01 (0.78, 1.30) |
Unhealthy | 17 | 1.79 (1.11, 2.89) * | 1.09 (0.48, 2.46) | 0.55 (0.18, 1.74) |
SO2 | ||||
Good | 693 | ---- | ---- | ---- |
Moderate | 80 | 0.96 (0.71, 1.29) | 1.18 (0.81, 1.71) | 0.88 (0.57, 1.36) |
Unhealthy | 17 | 1.51 (0.92, 2.48) | 1.07 (0.48, 2.41) | 2.07 (1.13, 3.79) * |
NO2 | ||||
Good | 790 | ---- | ---- | ---- |
Moderate | 0 | |||
Unhealthy | 0 |
Days | Daily Exacerbation Rate Ratios (95% CI) | |||
---|---|---|---|---|
AQI | N | Asthma | COPD | Bronchitis |
Overall | RR (95% CI) | RR (95% CI) | RR (95% CI) | |
Good | 416 | ---- | ---- | ---- |
Moderate | 337 | 0.90 (0.59, 1.37) | 1.06 (0.87, 1.28) | 1.04 (0.75, 1.45) |
Unhealthy | 37 | 0.44 (0.11, 1.81) | 0.97 (0.61, 1.54) | 0.73 (0.30, 1.80) |
Ozone | ||||
Good | 686 | ---- | ---- | ---- |
Moderate | 69 | 0.74 (0.32, 1.69) | 0.98 (0.70, 1.38) | 0.67 (0.34, 1.31) |
Unhealthy | 6 | No events | 0.92 (0.29, 2.86) | 1.71 (0.42, 6.89) |
PM2.5 | ||||
Good | 443 | ---- | ---- | ---- |
Moderate | 330 | 0.87 (0.57, 1.33) | 1.09 (0.90, 1.33) | 1.02 (0.73, 1.41) |
Unhealthy | 17 | 0.48 (0.07, 3.49) | 0.90 (0.44, 1.82) | 0.95 (0.30, 3.02) |
SO2 | ||||
Good | 693 | ---- | ---- | ---- |
Moderate | 80 | 1.22 (0.65, 2.30) | 1.12 (0.83, 1.52) | 1.22 (0.74, 2.00) |
Unhealthy | 17 | 0.52 (0.07, 3.76) | 1.21 (0.67, 2.21) | 0.32 (0.05, 2.28) |
NO2 | ||||
Good | 790 | ---- | ---- | ---- |
Moderate | 0 | |||
Unhealthy | 0 |
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Overall | Age Group: | |||
---|---|---|---|---|
<18 Years | 18–64 Years | ≥65 Years | ||
N = 117,545 | N = 23,050 | N = 70,280 | N = 24,215 | |
Sex: | ||||
Male | 55,531 (47.2%) | 11,836 (51.3%) | 32,728 (46.6%) | 10,967 (45.3%) |
Female | 62,014 (52.8%) | 11,214 (48.7%) | 36,778 (52.3%) | 14,022 (57.9%) |
Insurance: | ||||
Public | 53,151 (45.2%) | 11,212 (48.6%) | 18,711 (26.6%) | 23,592 (97.4%) |
Private | 64,394 (54.8%) | 11,838 (51.4%) | 51,569 (73.4%) | 623 (2.6%) |
Overall | Air Quality Index (790 Days) | ||||
---|---|---|---|---|---|
Mean (SD) | Median [IQR] | Good (AQI < 50) | Moderate (AQI 50–100) | Unhealthy (AQI >100) | |
AQI: | #Days (%) | #Days (%) | #Days (%) | ||
Overall | 53.1 (23.2) | 48.8 [36.5, 64.1] | 416 (52.7%) | 337 (42.7%) | 37 (4.7%) |
Ozone | 34.7 (16.5) | 32.4 [24.1, 41.7] | 686 (90.1%) | 69 (9.1%) | 6 (0.8%) |
PM2.5 | 48.1 (22.8) | 45.8 [30.8, 61.0] | 443 (56.1%) | 330 (41.8%) | 17 (2.2%) |
SO2 | 23.6 (24.6) | 15.7 [4.3, 34.3] | 693 (87.7%) | 80 (10.1%) | 17 (2.2%) |
NO2 | 18.8 (7.5) | 17.8 [13.4, 23.6] | 790 (100%) | ---- | ---- |
Mean (SD) | Mean (SD) | Mean (SD) | |||
Max Temp (F) | 60.1 (19.8) | 61.0 [42.0, 79.0] | 55.1 (19.1) | 66.1 (19.3) | 66.1 (19.3) * |
Wind Speed (mph) | 16.7 (6.8) | 16.0 [11.5, 21.0] | 17.9 (7.03) | 15.1 (6.2) | 17.6 (6.6) * |
RR Comparing AQI (>100 vs. ≤100) | Daily Exacerbation Rate Ratios (95% CI) | ||
---|---|---|---|
Asthma | Bronchitis | COPD | |
AQI Overall | RR (95% CI) | RR (95% CI) | RR (95% CI) |
LAG0 | 1.42 (1.05, 1.93) * | 1.01 (0.65, 1.58) | 0.95 (0.66, 1.36) |
LAG1 | 0.79 (0.54, 1.17) | 0.93 (0.59, 1.47) | 0.95 (0.67, 1.36) |
LAG5 | 1.04 (0.73, 1.47) | 1.11 (0.72, 1.70) | 1.17 (0.84, 1.62) |
meanLAG0–5 a | 0.78 (0.35, 1.74) | 0.83 (0.31, 2.22) | 1.27 (0.68, 2.36) |
AQI_PM2.5 b | |||
LAG0 | 1.60 (1.06, 2.43) * | 0.77 (0.36, 1.62) | 0.93 (0.55, 1.58) |
LAG1 | 0.96 (0.57, 1.63) | 0.99 (0.51, 1.91) | 0.86 (0.50, 1.50) |
LAG5 | 0.89 (0.51, 1.54) | 0.76 (0.36, 1.60) | 1.41 (0.91, 2.17) |
AQI_SO2 b | |||
LAG0 | 1.60 (1.06, 2.43) * | 1.33 (0.75, 2.36) | 1.14 (0.70, 1.84) |
LAG1 | 0.68 (0.37, 1.28) | 1.10 (0.59, 2.06) | 1.21 (0.76, 1.93) |
LAG5 | 1.24 (0.78, 1.98) | 1.76 (1.08, 2.93) * | 0.93 (0.55, 1.58) |
Asthma Exacerbation Rate Comparing AQI_ LAG0 > 100 vs. ≤100: | ||||
---|---|---|---|---|
AQI Overall RR (95% CI) | AQI Ozone RR (95% CI) | AQI PM2.5 RR (95% CI) | AQI SO2 RR (95% CI) | |
Stratum: | ||||
Overall | 1.42 (1.05, 1.93) * | 1.73 (0.56, 5.37) | 1.60 (1.06, 2.43) * | 1.60 (1.06, 2.43) * |
Age < 18 years | 2.32 (1.16, 4.62) * | 1.50 (0.21, 10.76) | 2.17 (0.79,5.90) | 3.33 (1.45, 7.62) * |
Sex: | ||||
Male | 1.85 (0.67, 5.15) | ---- | 3.03 (0.94, 9.75) | 1.98 (0.48, 8.14) |
Female | 2.91 (1.14, 7.42) * | 3.40 (0.50, 24.79) | 1.17 (0.16, 8.49) | 5.05 (1.80, 14.19) * |
Insurance: | ||||
Public | 2.47 (1.18, 5.14) * | 1.80 (0.25, 12.94) | 1.92 (0.61, 6.10) | 4.01 (1.74, 9.24) * |
Private a | 1.57 (0.21, 11.97) | ---- | ---- | ---- |
Age 18–64 years | 1.45 (1.02, 2.06) * | 0.52 (0.13, 2.10) | 1.71 (1.07, 2.74) * | 1.51 (0.92, 2.49) |
Sex: | ||||
Male | 1.61 (0.92, 2.84) | ---- | 1.87 (0.88, 3.99) | 2.15 (1.06, 4.37) * |
Female | 1.36 (0.86, 2.13) | 0.81 (0.20, 3.26) | 1.62 (0.89, 2.95) | 1.17 (0.58, 2.35) |
Insurance: | ||||
Public | 1.44 (0.90, 2.29) | 0.93 (0.23, 3.72) | 1.64 (0.87, 3.07) | 1.30 (0.64, 2.62) |
Private | 1.46 (0.85, 2.51) | ---- | 1.81 (0.89, 3.67) | 1.81 (0.89, 3.67) |
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Byrwa-Hill, B.M.; Morphew, T.; O’Neill, J.; Gentile, D. Air Quality Index as a Predictor of Respiratory Morbidity in At-Risk Populations. Int. J. Environ. Res. Public Health 2025, 22, 1493. https://doi.org/10.3390/ijerph22101493
Byrwa-Hill BM, Morphew T, O’Neill J, Gentile D. Air Quality Index as a Predictor of Respiratory Morbidity in At-Risk Populations. International Journal of Environmental Research and Public Health. 2025; 22(10):1493. https://doi.org/10.3390/ijerph22101493
Chicago/Turabian StyleByrwa-Hill, Brandy M., Tricia Morphew, John O’Neill, and Deborah Gentile. 2025. "Air Quality Index as a Predictor of Respiratory Morbidity in At-Risk Populations" International Journal of Environmental Research and Public Health 22, no. 10: 1493. https://doi.org/10.3390/ijerph22101493
APA StyleByrwa-Hill, B. M., Morphew, T., O’Neill, J., & Gentile, D. (2025). Air Quality Index as a Predictor of Respiratory Morbidity in At-Risk Populations. International Journal of Environmental Research and Public Health, 22(10), 1493. https://doi.org/10.3390/ijerph22101493