Ozone pollution and asthma emergency department visits in Fresno, CA, USA, during the warm season (June–September) of the years 2005 to 2015: a time-stratified case-crossover analysis

  • Marcela R. Entwistle
  • Hamed Gharibi
  • Pooya Tavallali
  • Ricardo CisnerosEmail author
  • Donald Schweizer
  • Paul Brown
  • Sandie Ha


Fresno, located at the central part of the San Joaquin Valley (SJV), CA, USA, is one of the most air-polluted cities in North America. The present time-stratified case-crossover study investigates whether short-term exposure to ozone (O3) is associated with asthma emergency departments (ED) visits during the high O3 warm seasons (June–September) of 2005 to 2015 in Fresno, CA, USA. A total of 4463 ED visits from 2005 to 2015 in Fresno were identified. The potential effect modification by land use (commercial and residential), sex, race (White, Black, and Hispanic), and age (2–5, 6–18, 19–40, 41–64, and > = 65) was investigated. A 5 ppb increase in the concentration of O3 at the lag 0–14 was associated with 33.6% increase in the odds of having an asthma ED visit [OR 1.336 (95% confidence intervals 1.262, 1.414)]. People living in commercial areas (OR 1.470 (95% confidence intervals 1.353, 1.597) at lag 0–14) experienced higher odds of visiting the ED due to asthma when compared to those living in residential areas (OR 1.193 (95% confidence intervals 1.084, 1.313) at lag 0–14). Sex was not a modifier in this study. Blacks and Hispanics showed faster response to O3 exposure. The association between O3 exposure and asthma ED visits was positive among all age groups, but greater among 6 to 18 years. Ozone exposure is associated with asthma ED visits in Fresno during the warm seasons (June–September) of 2005 to 2015.


Asthma attacks Time-stratified case-crossover Ozone Fresno, California 



We would like to thank the California’s Office of Statewide Health Planning and Development (OSHPD) for providing us with the data and those who helped us in conducting this research.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

11869_2019_685_MOESM1_ESM.docx (16 kb)
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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Marcela R. Entwistle
    • 1
  • Hamed Gharibi
    • 1
    • 2
  • Pooya Tavallali
    • 3
  • Ricardo Cisneros
    • 1
    • 4
    Email author
  • Donald Schweizer
    • 1
    • 4
  • Paul Brown
    • 1
    • 2
  • Sandie Ha
    • 2
  1. 1.Health Sciences Research InstituteUniversity of California MercedMercedUSA
  2. 2.Department of Public Health, College of Social Sciences, Humanities and ArtsUniversity of CaliforniaMercedUSA
  3. 3.Electrical Engineering and Computer ScienceUniversity of CaliforniaMercedUSA
  4. 4.USDA Forest Service, Pacific Southwest RegionClovisUSA

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