Association of Ambient Air Pollution on Pediatric and Adult Otitis Media Rates in the US

Introduction: Ambient air pollution, especially levels of particulate matter with diameter less than 2.5 micrometers (PM2.5), can impact rates of acute and chronic rhinosinusitis but its role is less well characterized for otitis media (OM) across all ages. This study aims to characterize this association using a nationally representative database.

Methods: Using EPA AirNow (2021-2024), we identified the 50 highest and 50 lowest air pollution ZIP code areas in the nation based on mean PM2.5 and obtained the air quality index (AQI). Epic Cosmos provided OM encounters aggregated by ZIP code and quarter. Rates per 1,000 population were modeled with multivariable negative binomial regression with population offsets and ZIP-clustered robust standard errors, adjusting for year, quarter, and urbanicity. We estimated effects of pollution group and continuous AQI per 1 standard deviation.

Results: 147,846 OM encounters were included. After adjustment, the highest pollution areas had higher OM rates than the lowest pollution areas in children (IRR 2.09, 95% CI 1.85-2.36) and adults (IRR 1.51, 95% CI 1.37-1.66). OM rates demonstrated seasonal variation, with higher rates in Q4 versus Q1 for children (IRR 1.52, 95% CI 1.29-1.79) and adults (IRR 1.24, 95% CI 1.08-1.42). Each 1 SD higher AQI was associated with higher OM rates (pediatric IRR 1.35, 95% CI 1.27-1.42; adult IRR 1.16, 95% CI 1.11-1.21).

Conclusions: In this ecological analysis, higher ambient pollution burden was associated with higher pediatric and adult OM encounter rates, with strong seasonal peaks in Q4. Associations were observed both for a high- versus low-pollution contrast and for continuous AQI, supporting a relationship between ambient air quality and OM.