Repeated hospital encounters for asthma in children and exposure to traffic-related air pollution near the home
Repeated hospital encounters for asthma in children and exposure to traffic-related air pollution near the home
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DOI：
10.1016/s1081-1206(10)60244-x
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发表时间：
2009-02-01
影响因子：
5.9
通讯作者：
Gillen, Daniel L.
中科院分区：
文献类型：
--
作者：
Delfino, Ralph J.;Chang, Joyce;Gillen, Daniel L.
背景：哮喘的住院总次数(入院或急诊科就诊)与每天的区域空气污染有关。目的：评估当地交通产生的空气污染与儿童哮喘反复住院之间的关系。方法：在加利福尼亚州奥兰治县北部的两家医院的集水区，获得2768名0-18岁儿童的住院记录，其中697人曾两次住院。住宅地址进行了地理编码。线源扩散模型被用来估计从第一次医院遭遇开始纵向上个人对当地交通产生的污染物(氮氧化物和一氧化碳)的季节性暴露。使用经常性比例风险分析来估计暴露于空气污染的风险，调整了性别、年龄、医疗保险、人口普查得出的贫困、种族/民族、居住到医院的距离和季节。结果：氮氧化物(4.00ppb)和一氧化碳(0.056 ppm)四分位数范围增加的调整危险比分别为1.10(95%可信区间，1.03-1.16)和1.07(1.01-1.14)。女孩和婴儿的关联性最强，但与其他群体没有显着差异。来自高收入群体(趋势为P<；0.09)的儿童中更强的相关性可能是由于更准确的数据。结论：反复在医院相遇的相关性表明，家庭附近当地产生的空气污染影响儿童哮喘的严重程度。风险可能从婴儿期开始，并持续到儿童后期，那时哮喘的诊断更加明确。
Background: Aggregate hospital encounters for asthma (admissions or emergency department visits) have been associated with daily regional air pollution. There are fewer data on relationships between repeated hospital encounters and traffic-related air pollution near the home.Objective: To estimate the association of local traffic-generated air pollution with repeated hospital encounters for asthma in children.Methods: Hospital records for 2,768 children aged 0 to 18 years (697 of whom had >= 2 encounters) were obtained for a catchment area of 2 hospitals in northern Orange County, California. Residential addresses were geocoded. A line source dispersion model was used to estimate individual seasonal exposures to local traffic-generated pollutants (nitrogen oxides and carbon monoxide) longitudinally beginning with the first hospital encounter. Recurrent proportional hazards analysis was used to estimate risk of exposure to air pollution adjusting for sex, age, health insurance, census-derived poverty, race/ethnicity, residence distance to hospital, and season. The adjustment variables and census-derived median household income were tested for effect modification.Results: Adjusted hazard ratios for interquartile range increases in nitrogen oxides (4.00 ppb) and carbon monoxide (0.056 ppm) were 1.10 (95% confidence interval, 1.03-1.16) and 1.07 (1.01-1.14), respectively. Associations were strongest for girls and infants but were not significantly different from other groups. Stronger associations in children from higher-income block groups (P < .09 for trend) may have been due to more accurate data.Conclusions: Associations for repeated hospital encounters suggest that locally generated air pollution near the home affects asthma severity in children. Risk may begin during infancy and continue in later childhood, when asthma diagnoses are clearer.