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Open Forum Infect Dis
. 2025 Oct 10;12(10):ofaf442.
doi: 10.1093/ofid/ofaf442. eCollection 2025 Oct. Association Between Fine Particulate Matter (PM2.5) and Severity of Acute Respiratory Infections Among Young US Children in the Major Cities in the United States: A Claims-based Cohort Study
Damien Foo 1 , Annette K Regan 2 3 4 , Seulkee Heo 1 , Eric B Schneider 5 , Joseph Canner 5 , Yimeng Song 1 , Michelle L Bell 1
Affiliations
Background: Acute respiratory infections (ARIs) are a leading cause of morbidity and mortality among children. Air pollution may play a role in the exacerbation of ARIs via inflammation, immunosuppression, and oxidative stress, yet this effect has been infrequently evaluated among children.
Objectives: Evaluate the impact of short-term exposure to fine particulate matter (PM2.5) to ARI severity among US children aged <5 years.
Methods: We analyzed data from a claims-based cohort of children included in a private health insurance plan (Merative™ MarketScan® Commercial Claims and Encounters database) who were diagnosed with an ARI between January 2018 and March 2020. We use daily monitored PM2.5 concentrations at the metropolitan statistical area level to estimate the short-term weekly PM2.5 exposure. We evaluated the association between short-term PM2.5 exposure and the risk of prescription claim for antiviral medication, hospital admissions and readmissions for an ARI, intensive care unit (ICU) admission for an ARI, mechanical ventilation, and length of stay among hospital-admitted and ICU-admitted children using generalized linear models.
Results: The risk of an antiviral prescription claim increased by 11% (95% confidence interval, 1.07-1.15) per interquartile range increase in PM2.5 exposure (3.34 µg/m3); this association was consistent regardless of age, biological sex, and influenza vaccination status. We observed a 6% increased risk of ICU admission (95% confidence interval, 1.02-1.10) among children not vaccinated against influenza and no increase among vaccinated children.
Conclusions: Short-term PM2.5 exposure may contribute to ARI severity among children. Influenza vaccination may modify the risk of severe ARI-associated outcomes.
Keywords: acute respiratory infection; air pollution; antiviral medication; particulate matter; severity.
. 2025 Oct 10;12(10):ofaf442.
doi: 10.1093/ofid/ofaf442. eCollection 2025 Oct. Association Between Fine Particulate Matter (PM2.5) and Severity of Acute Respiratory Infections Among Young US Children in the Major Cities in the United States: A Claims-based Cohort Study
Damien Foo 1 , Annette K Regan 2 3 4 , Seulkee Heo 1 , Eric B Schneider 5 , Joseph Canner 5 , Yimeng Song 1 , Michelle L Bell 1
Affiliations
- PMID: 41141444
- PMCID: PMC12548786
- DOI: 10.1093/ofid/ofaf442
Background: Acute respiratory infections (ARIs) are a leading cause of morbidity and mortality among children. Air pollution may play a role in the exacerbation of ARIs via inflammation, immunosuppression, and oxidative stress, yet this effect has been infrequently evaluated among children.
Objectives: Evaluate the impact of short-term exposure to fine particulate matter (PM2.5) to ARI severity among US children aged <5 years.
Methods: We analyzed data from a claims-based cohort of children included in a private health insurance plan (Merative™ MarketScan® Commercial Claims and Encounters database) who were diagnosed with an ARI between January 2018 and March 2020. We use daily monitored PM2.5 concentrations at the metropolitan statistical area level to estimate the short-term weekly PM2.5 exposure. We evaluated the association between short-term PM2.5 exposure and the risk of prescription claim for antiviral medication, hospital admissions and readmissions for an ARI, intensive care unit (ICU) admission for an ARI, mechanical ventilation, and length of stay among hospital-admitted and ICU-admitted children using generalized linear models.
Results: The risk of an antiviral prescription claim increased by 11% (95% confidence interval, 1.07-1.15) per interquartile range increase in PM2.5 exposure (3.34 µg/m3); this association was consistent regardless of age, biological sex, and influenza vaccination status. We observed a 6% increased risk of ICU admission (95% confidence interval, 1.02-1.10) among children not vaccinated against influenza and no increase among vaccinated children.
Conclusions: Short-term PM2.5 exposure may contribute to ARI severity among children. Influenza vaccination may modify the risk of severe ARI-associated outcomes.
Keywords: acute respiratory infection; air pollution; antiviral medication; particulate matter; severity.