Environment/Climate Change
Associations of Land Cover, Greenness, Weather, and Community Type with Radiologic Sinus Inflammation Margaret Tomann* Margaret Tomann Brian S. Schwartz Annemarie G. Hirsch Jonathan Pollak Joseph Dewalle
Chronic rhinosinusitis (CRS) is a disease of the nasal and sinus mucosa with substantial direct and indirect costs for individuals and society and elevated risk of transition to lower airway diseases. Climate change-driven variation in weather and land use may contribute to increases in levels and allergenicity of aeroallergens. We aimed to evaluate associations of land cover, greenness, weather, and community type with radiologic sinus inflammation (RSI), an objective finding of CRS, using electronic health records from Geisinger in 37 counties of Pennsylvania.
In a nested case-control study we included individuals aged 18 – 80 years from 2008 – 2018. Cases (n = 2382) with RSI were identified using a validated text algorithm applied to sinus computed tomography scan reports. Controls (n = 11,910) were frequency matched on age, sex, and year. Land cover, greenness, and weather metrics were assigned in a 1250-meter residential buffer and incorporated 3-month latency and 3-month duration (L3D3). Sensitivity analyses evaluated 3-month latency, 6-month duration (L3D6). Logistic regression with robust standard errors was used to estimate associations (odds ratio [OR], 95% confidence interval [95% CI]) while adjusting for confounding variables.
Cases and controls (n = 14,289) had mean (SD) age of 49.5 (15.3) years, were predominantly non-Hispanic White (96%) and had mean (SD) contact time with Geisinger of 5.88 (3.29) years. Associations (OR, 95% CI) with L3D3 (primary analysis) were weaker than L3D6 (sensitivity). Increasing urbanization was associated with increased odds (vs. rural) of RSI: suburban – small town (1.25, 1.12–1.38), lower density urban (1.33, 1.17–1.53), higher density urban (1.47, 1.23–1.76). Increasing greenness was associated with increased odds (vs. quartile 1) of RSI: quartile 2 (1.00, 0.88–1.15), quartile 3 (1.15, 1.01–1.30), quartile 4 (1.20, 1.06–1.37). These associations suggest that air pollution and aeroallergens may each play a role in RSI.