Associations between illness-related absences and ventilation and indoor PM_2.5 in elementary schools of the Midwestern United States

This study monitored indoor environmental data in 144 classrooms in 31 schools in the Midwestern United States for two consecutive days every fall, winter, and spring during a two-year period; 3,105 pupils attended classrooms where the measurements were conducted. All classrooms were ventilated with mechanical systems that had recirculation; there were no operable exterior windows or doors. The daily absence rate at the student level and demographic data at the classroom level were collected. The overall mean ventilation rate, using outdoor air, was 5.5 L/s per person (the corresponding mean carbon dioxide concentrations were <2,000 ppm), and the mean indoor PM_2.5 was 3.6 μg/m³. The annual illness-related absence rate at the classroom level was extracted from the student-level absence data and regressed on measured indoor environmental parameters. Significant associations were found. Every 1 L/s per person increase in ventilation rate decreased the annual absence rate by 5.59 days, corresponding to a 0.15% increase in the average daily attendance rate, while every additional 1 μg/m³ of indoor PM_2.5 was associated with an increased annual absence rate of 7.37 days, corresponding to a 0.19% increase in average daily attendance rate. No other relationships were significant. Present results agree with the previously demonstrated benefits of reduced absence rates when classroom ventilation is improved and provide additional evidence on the potential benefits of reducing indoor inhalable particles. Overall, reduced absence rates are expected to provide socioeconomic benefits and benefits for academic achievements, while higher ventilation rates and reduced particle levels will also contribute to reduced health risks, including those related to airborne respiratory pathogens.