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Effect of ambient air pollution on the incidence of appendicitis

journal contribution
posted on 2023-05-18, 10:32 authored by Kaplan, GG, Elijah, D, Panaccione, R, Fong, A, Chen, L, Szyszkowicz, M, Amanda WheelerAmanda Wheeler, MacLean, A, Buie, WD, Leung, T, Heitman, SJ, Villeneuve, PJ

Background: The pathogenesis of appendicitis is unclear. We evaluated whether exposure to air pollution was associated with an increased incidence of appendicitis.

Methods: We identified 5191 adults who had been admitted to hospital with appendicitis between Apr. 1, 1999, and Dec. 31, 2006. The air pollutants studied were ozone, nitrogen dioxide, sulfur dioxide, carbon monoxide, and suspended particulate matter of less than 10 µ and less than 2.5 µ in diameter. We estimated the odds of appendicitis relative to short-term increases in concentrations of selected pollutants, alone and in combination, after controlling for temperature and relative humidity as well as the effects of age, sex and season.

Results: An increase in the interquartile range of the 5- day average of ozone was associated with appendicitis (odds ratio [OR] 1.14, 95% confidence interval [CI] 1.03– 1.25). In summer (July–August), the effects were most pronounced for ozone (OR 1.32, 95% CI 1.10–1.57), sulfur dioxide (OR 1.30, 95% CI 1.03–1.63), nitrogen dioxide (OR 1.76, 95% CI 1.20–2.58), carbon monoxide (OR 1.35, 95% CI 1.01–1.80) and particulate matter less than 10 µ in diameter (OR 1.20, 95% CI 1.05–1.38). We observed a significant effect of the air pollutants in the summer months among men but not among women (e.g., OR for increase in the 5-day average of nitrogen dioxide 2.05, 95% CI 1.21–3.47, among men and 1.48, 95% CI 0.85– 2.59, among women). The double-pollutant model of exposure to ozone and nitrogen dioxide in the summer months was associated with attenuation of the effects of ozone (OR 1.22, 95% CI 1.01–1.48) and nitrogen dioxide (OR 1.48, 95% CI 0.97–2.24).

Interpretation: Our findings suggest that some cases of appendicitis may be triggered by short-term exposure to air pollution. If these findings are confirmed, measures to improve air quality may help to decrease rates of appendicitis.


Publication title

C M A J: (Canadian Medical Association Journal)










Menzies Institute for Medical Research


Canadian Medical Association

Place of publication

1867 Alta Vista Dr, Ottawa, Canada, Ontario, K1G 3Y6

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Copyright 2009 Canadian Medical Association or its licensors

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Socio-economic Objectives

Public health (excl. specific population health) not elsewhere classified

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