Repeated respiratory hospital encounters among children with asthma and residential proximity to traffic
Repeated respiratory hospital encounters among children with asthma and residential proximity to traffic
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DOI：
10.1136/oem.2008.039412
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发表时间：
2009-02-01
影响因子：
4.9
通讯作者：
Cooper, D.
中科院分区：
文献类型：
--
作者：
Chang, J.;Delfino, R. J.;Cooper, D.
目的：儿童不良呼吸结果的患病率经常与交通相关暴露的测量相关，其他数据表明哮喘严重程度随着居住在交通繁忙的地方而恶化。我们研究了邻里交通负担和反复急性呼吸道疾病，需要急诊科就诊和/或住院治疗的儿童与哮喘（89%急性支气管炎或肺炎）的主要或次要诊断之间的关联：这是一个以医院为基础的纵向研究南部加州城市集水区周围两个相邻的儿童医院。受试者的家庭地址被地理编码并与附近的交通数据相关联。结果：我们发现居住在主干道或高速公路300米以内的3297名18岁或以下儿童的重复医院遭遇风险增加，交通密度最高的五分之一儿童的风险最高（HR=1.21; 95% CL 0.99至1.49）和居住地300米范围内有750米或更长的主干道和高速公路（HR=1.18; 95% CL 0.99至1.41）。反复医院接触和居住在交通繁忙的地方之间的联系在女性比男性更强，在没有保险的儿童或需要政府赞助的保险的儿童比有私人保险的儿童更强。性别差异是最显着的婴儿（0岁）和儿童年龄6-18 years.Conclusions：结果表明，暴露于交通相关的空气污染增加哮喘的严重程度所示的医院利用率。在婴儿中的发现表明这是一个特别脆弱的人群，尽管在这个年龄诊断哮喘的有效性尚不清楚。没有私人保险的妇女和儿童也可能更容易受到交通造成的空气污染的影响。
Objective: The prevalence of adverse respiratory outcomes among children has been frequently associated with measurements of traffic-related exposures, and other data suggest asthma severity is worsened with residence near heavy traffic. We examined the association between neighbourhood traffic burden and repeated acute respiratory illnesses that required emergency department visits and/or hospitalisation for children with a primary or secondary diagnosis of asthma (89% acute bronchitis or pneumonia).Methods: This is a hospital-based longitudinal study of a southern California urban catchment area around two adjacent children's hospitals. Subjects' home addresses were geocoded and linked to nearby traffic data. Recurrent event proportional hazard analysis was used to estimate the hazard of repeated hospital encounters.Results: We found living within 300 metres of arterial roads or freeways increased risk of repeated hospital encounters in 3297 children age 18 years or less. At highest risk were children in the top quintile of traffic density (HR=1.21; 95% CL 0.99 to 1.49) and those who had 750 metres or more of arterial road and freeway length within 300 metres of their residence (HR=1.18; 95% CL 0.99 to 1.41). Associations between repeated hospital encounters and residence near heavy traffic were stronger in females than males and in children without insurance or who required government sponsored insurance than children with private insurance. The gender disparity was most notable among infants (age 0) and children ages 6-18 years.Conclusions: Results suggest exposure to traffic-related air pollution increases asthma severity as indicated by hospital utilisation. The finding in infants suggests this is an especially vulnerable population, although the validity of asthma diagnosis at this age is unknown. Females and children who do not have private insurance may also be more vulnerable to air pollution from traffic.