Short-Term Nitrogen Dioxide Exposure and Emergency Hospital Admissions for Asthma in Children: A Case-Crossover Analysis in England

IF 3.7 3区医学 Q2 ALLERGY

Journal of Asthma and Allergy Pub Date : 2024-04-09 DOI:10.2147/jaa.s448600

Weiyi Wang, John Gulliver, Sean Beevers, Anna Freni Sterrantino, Bethan Davies, Richard W Atkinson, Daniela Fecht

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引用次数: 0

Abstract

Background: There is an increasing body of evidence associating short-term ambient nitrogen dioxide (NO₂) exposure with asthma-related hospital admissions in children. However, most studies have relied on temporally resolved exposure information, potentially ignoring the spatial variability of NO₂. We aimed to investigate how daily NO₂ estimates from a highly resolved spatio-temporal model are associated with the risk of emergency hospital admission for asthma in children in England.
Methods: We conducted a time-stratified case-crossover study including 111,766 emergency hospital admissions for asthma in children (aged 0– 14 years) between 1st January 2011 and 31st December 2015 in England. Daily NO₂ levels were predicted at the patients’ place of residence using spatio-temporal models by combining land use data and chemical transport model estimates. Conditional logistic regression models were used to obtain the odds ratios (OR) and confidence intervals (CI) after adjusting for temperature, relative humidity, bank holidays, and influenza rates. The effect modifications by age, sex, season, area-level income deprivation, and region were explored in stratified analyses.
Results: For each 10 μg/m³ increase in NO₂ exposure, we observed an 8% increase in asthma-related emergency admissions using a five-day moving NO₂ average (mean lag 0– 4) (OR 1.08, 95% CI 1.06– 1.10). In the stratified analysis, we found larger effect sizes for male (OR 1.10, 95% CI 1.07– 1.12) and during the cold season (OR 1.10, 95% CI 1.08– 1.12). The effect estimates varied slightly by age group, area-level income deprivation, and region.
Significance: Short-term exposure to NO₂ was significantly associated with an increased risk of asthma emergency admissions among children in England. Future guidance and policies need to consider reflecting certain proven modifications, such as using season-specific countermeasures for air pollution control, to protect the at-risk population.

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短期二氧化氮暴露与儿童哮喘急诊入院：英格兰病例交叉分析

背景：越来越多的证据表明，短期环境二氧化氮（NO2）暴露与儿童因哮喘入院有关。然而，大多数研究都依赖于时间分辨的暴露信息，可能忽略了二氧化氮的空间变异性。我们的目的是调查高度分辨的时空模型得出的每日二氧化氮估计值与英格兰儿童因哮喘而紧急入院的风险有何关联：我们进行了一项时间分层病例交叉研究，研究对象包括 2011 年 1 月 1 日至 2015 年 12 月 31 日期间因哮喘紧急入院的 111,766 名英格兰儿童（0-14 岁）。通过结合土地利用数据和化学迁移模型估计值，使用时空模型预测了患者居住地的每日二氧化氮水平。在对温度、相对湿度、银行假日和流感发病率进行调整后，使用条件逻辑回归模型得出了几率比（OR）和置信区间（CI）。在分层分析中，探讨了年龄、性别、季节、地区收入贫困程度和地区的影响修正：二氧化氮暴露量每增加 10 微克/立方米，使用五天移动二氧化氮平均值（平均滞后 0-4），我们观察到哮喘相关急诊入院率增加了 8%（OR 1.08，95% CI 1.06-1.10）。在分层分析中，我们发现男性（OR 1.10，95% CI 1.07-1.12）和寒冷季节（OR 1.10，95% CI 1.08-1.12）的影响更大。不同年龄组、地区收入水平和地区的效应估计值略有不同：短期暴露于二氧化氮与英格兰儿童哮喘急诊入院风险的增加密切相关。未来的指导意见和政策需要考虑反映某些已被证实的调整措施，如采用针对不同季节的空气污染控制对策，以保护高危人群。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Asthma and Allergy Medicine-Immunology and Allergy

CiteScore

5.30

自引率

6.20%

发文量

185

审稿时长

16 weeks

期刊介绍： An international, peer-reviewed journal publishing original research, reports, editorials and commentaries on the following topics: Asthma; Pulmonary physiology; Asthma related clinical health; Clinical immunology and the immunological basis of disease; Pharmacological interventions and new therapies. Although the main focus of the journal will be to publish research and clinical results in humans, preclinical, animal and in vitro studies will be published where they shed light on disease processes and potential new therapies.