{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T13:30:56Z","timestamp":1771680656614,"version":"3.50.1"},"reference-count":85,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2021,12,8]],"date-time":"2021-12-08T00:00:00Z","timestamp":1638921600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Boston University School of Public Health"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Many areas of the United States have air pollution levels typically below Environmental Protection Agency (EPA) regulatory limits. Most health effects studies of air pollution use meteorological (e.g., warm\/cool) or astronomical (e.g., solstice\/equinox) definitions of seasons despite evidence suggesting temporally-misaligned intra-annual periods of relative asthma burden (i.e., \u201casthma seasons\u201d). We introduce asthma seasons to elucidate whether air pollutants are associated with seasonal differences in asthma emergency department (ED) visits in a low air pollution environment. Within a Bayesian time-stratified case-crossover framework, we quantify seasonal associations between highly resolved estimates of six criteria air pollutants, two weather variables, and asthma ED visits among 66,092 children ages 5\u201319 living in South Carolina (SC) census tracts from 2005 to 2014. Results show that coarse particulates (particulate matter &lt;10 \u03bcm and &gt;2.5 \u03bcm: PM<jats:sub>10-2.5<\/jats:sub>) and nitrogen oxides (NO<jats:sub>x<\/jats:sub>) may contribute to asthma ED visits across years, but are particularly implicated in the highest-burden fall asthma season. Fine particulate matter (&lt;2.5 \u03bcm: PM<jats:sub>2.5<\/jats:sub>) is only associated in the lowest-burden summer asthma season. Relatively cool and dry conditions in the summer asthma season and increased temperatures in the spring and fall asthma seasons are associated with increased ED visit odds. Few significant associations in the medium-burden winter and medium-high-burden spring asthma seasons suggest other ED visit drivers (e.g., viral infections) for each, respectively. Across rural and urban areas characterized by generally low air pollution levels, there are acute health effects associated with particulate matter, but only in the summer and fall asthma seasons and differing by PM size.<\/jats:p>","DOI":"10.1371\/journal.pone.0260264","type":"journal-article","created":{"date-parts":[[2021,12,8]],"date-time":"2021-12-08T18:22:12Z","timestamp":1638987732000},"page":"e0260264","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Using Bayesian time-stratified case-crossover models to examine associations between air pollution and \u201casthma seasons\u201d in a low air pollution environment"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0429-0247","authenticated-orcid":true,"given":"Matthew","family":"Bozigar","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8751-4551","authenticated-orcid":true,"given":"Andrew B.","family":"Lawson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John L.","family":"Pearce","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erik R.","family":"Svendsen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John E.","family":"Vena","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,12,8]]},"reference":[{"key":"pone.0260264.ref001","first-page":"6","article-title":"Health care utilization by children with asthma","author":"H Kim","year":"2009","journal-title":"Prev Chronic Dis."},{"key":"pone.0260264.ref002","first-page":"123","article-title":"Complex interactions of pollutant and allergen exposures and their impact on people with asthma","author":"PA Eggleston","year":"2009","journal-title":"Pediatrics"},{"key":"pone.0260264.ref003","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1097\/EDE.0000000000000016","article-title":"Asthma morbidity and ambient air pollution","volume":"25","author":"RJ Delfino","year":"2014","journal-title":"Epidemiology"},{"key":"pone.0260264.ref004","doi-asserted-by":"crossref","first-page":"e0174050","DOI":"10.1371\/journal.pone.0174050","article-title":"Effect of outdoor air pollution on asthma exacerbations in children and adults: Systematic review and multilevel meta-analysis","volume":"12","author":"P Orellano","year":"2017","journal-title":"PLoS One"},{"key":"pone.0260264.ref005","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1093\/biostatistics\/kxu058","article-title":"Bayesian kernel machine regression for estimating the health effects of multi-pollutant mixtures","volume":"16","author":"JF Bobb","year":"2015","journal-title":"Biostatistics"},{"key":"pone.0260264.ref006","first-page":"1","article-title":"Associations between ambient air pollutant mixtures and pediatric asthma emergency department visits in three cities: A classification and regression tree approach","volume":"14","author":"K Gass","year":"2015","journal-title":"Environ Heal A Glob Access Sci Source"},{"key":"pone.0260264.ref007","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1016\/j.jaip.2013.07.009","article-title":"Overweight\/obesity and risk of seasonal asthma exacerbations","volume":"1","author":"M Schatz","year":"2013","journal-title":"J Allergy Clin Immunol Pract"},{"key":"pone.0260264.ref008","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1164\/rccm.200908-1201OC","article-title":"Short-term associations between ambient air pollutants and pediatric asthma emergency department visits","volume":"182","author":"MJ Strickland","year":"2010","journal-title":"Am J Respir Crit Care Med"},{"key":"pone.0260264.ref009","doi-asserted-by":"crossref","first-page":"110115","DOI":"10.1016\/j.envres.2020.110115","article-title":"Season-stratified effects of meteorological factors on childhood asthma in Shanghai","volume":"191","author":"Y Hu","year":"2020","journal-title":"China. 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