The effects of air pollutants and meteorological factors on the occurrence and regression of coronary artery lesions in Kawasaki disease: a study combining case-control and cohort studies.

Abstract

Background: We evaluated the effects of environmental factors on the occurrence and regression of coronary artery lesions (CAL) in patients with Kawasaki disease (KD), intending to provide a scientific basis for the prevention, treatment, and long-term management of KD.

Methods: We enrolled pediatric patients with KD hospitalized in the Pediatric Cardiovascular Department of a tertiary comprehensive hospital between June 2015 and December 2020 as research subjects. The medical record information of the children during hospitalization and follow-up was obtained by reviewing the hospital's electronic medical record system. The air pollutants including CO, NO₂, PM₁₀, PM_2.5, SO₂ and O₃ were collected from the National Urban Air Quality Real-time Release Platform of the China National Environmental Monitoring Centre. The meteorological data were sourced from the China Meteorological Data Network, including the daily average temperature and the daily average relative humidity. We assessed the individual and combined effects of air pollutants and meteorological factors on CAL by Unconditional logistic regression and Bayesian kernel regression, respectively, and to explore their dose-response relationships. We estimated the overall time to regression of CAL by Kaplan-Meier, assessed the effects of air pollutants and meteorological factors on the regression of CAL by Cox proportional risk regression model, and evaluated the dose-response relationship by restricted cubic spline.

Results: The OR for CAL formation in children with KD was 1.267 (95% CI: 1.060-1.514) for every 10 µg/m³ increase in SO₂ concentration, and the risk of CAL formation gradually increased with increasing SO₂ concentration (P_overall=0.027, P_nonlinear=0.329). The HR for regression of CAL in KD children was 0.387 (95% CI: 0.174-0.861) for each 1mg/m³ increase in CO concentration, and the likelihood of CAL regression gradually decreased with increasing air CO concentration (P_overall=0.030, P_nonlinear=0.182).

Conclusion: Atmospheric SO₂ exposure was significantly associated with CAL occurrence in children with KD in this study, and there is a dose-response relationship. Atmospheric CO exposure was an independent risk factor preventing CAL regression in children with KD, and there was a dose-response relationship between atmospheric CO concentration and CAL regression. These findings indicate that relevant departments should take measures to strengthen the monitoring and control of environmental factors.