Air pollution, pollen, asthma and hayfever and their interactive effect on cognitive development: environment & health data linkage feasibility study

哮喘恶化是呼吸急促、咳嗽、喘息和胸闷中的一种或多种。高水平的空气污染和花粉（空气过敏原）被认为与哮喘恶化和花粉热有关。某些类型的空气污染和花粉被认为会增加哮喘恶化的可能性。对儿童认知发展的研究以前仅限于小规模的研究，因为需要招募参与者完成详细的测试。有研究调查是否有哮喘和花粉症的儿童在考试中表现不如没有哮喘或花粉症的儿童。以前的研究发现了不同的结果;一项研究发现，哮喘儿童的成绩略有增加，但研究人员没有使用儿童暴露于空气污染或花粉。需要进一步的研究来充分探索空气污染和花粉对患有和不患有哮喘和花粉热的儿童的教育程度的影响。在我们的研究中，我们将使用数据链接方法将每个儿童的空气污染，健康和教育数据以及定期收集的环境，健康和教育数据汇总在一起。SAIL数据库包含大量儿童的日常数据，能够利用每个儿童的教育程度作为认知发展的替代。我们的研究将包括一个城市的所有22，000名儿童，针对连续几年（2003 - 2012年）参加考试的不同儿童群体。我们的研究将包括空气污染的空间差异，介绍哮喘和非哮喘组儿童之间的差异。这将使我们能够直接证明空气污染对教育成就的影响。我们将首次使用儿童家庭和学校的污染水平，使用新的数据链接方法。我们将使用有关他们的家庭类型和年龄的数据，这些数据可能会改变孩子呼吸的空气污染量，承认孩子们在室内度过的时间。我们还将与他们的家庭其他成员进行数据链接，以调查他们是否与吸烟者住在一起。我们将使用有关每个孩子的数据，例如，每个孩子是否有资格获得免费学校餐。这将有助于考虑孩子是否来自低工资的家庭，从而消除我们的研究只会发现由于剥夺而导致的已知差异的可能性。我们还将包括孩子的出生周和性别。我们使用的统计方法将使我们能够研究来自许多不同学校的儿童，即使学校之间存在系统性差异，导致不同的结果。利用学校的特点，如贫困、性别混合和总体出勤率，尽可能多地纳入我们所掌握的信息，将使我们知道这些因素对我们的教育成果有多大影响。我们目前的可行性研究将利用家庭和学校的空气污染水平，包括生活在不同街道的儿童的变化;我们将限制我们的分析仅使用关键预检查期的空气污染和花粉总结。也就是说，我们将只分析空气污染和花粉对教育程度的短期影响。我们将评估在关键的考前时期增加的空气污染和花粉是否与易感个体的考试结果变化有关。在可行性研究即将结束时的一次研讨会上，该团队和利益攸关方将评估创建一个数据集所需的数据，以分析暴露于不同水平的空气污染和花粉的长期影响，从母婴对和母亲的教育程度开始，包括母亲在怀孕期间暴露的环境。关键词：空气污染、花粉和哮喘、花粉热、教育程度

Asthma exacerbations are one, or a combination of; shortness of breath, coughing, wheezing and chest tightness. High levels of air pollution and pollen (aeroallergens) are each thought to be associated with instances of asthma exacerbations and hayfever. In combination, some types of air pollution and pollen are thought to increase the likelihood of asthma exacerbations. Research into child cognitive development has been limited previously to small-scale studies through the necessity of recruiting participants to complete detailed tests. There have been studies investigating if children with asthma and hayfever perform less well in their examinations compared to children without asthma or hayfever. Previous studies have found differing results; one study found that attainment increased slightly for children with asthma, but researchers did not use the child's exposure to air pollution or pollen. Further research is needed to fully explore the influence of air pollution and pollen on educational attainment for children with and without asthma and hayfever. In our study we will bring together air pollution, health and education data for each child using data linkage methods, and routinely collected environment, health and education data. The SAIL databank, containing routine data for large numbers of children, is able to use educational attainment for each child as a substitute for cognitive development. Our study will include all 22,000 children resident in a city, for different groups of children who took exams in several successive years (2003 - 2012). Our study will include spatial differences in air pollution, introducing differences between children within the asthma and non-asthma groups. This will allow us to directly evidence the impact of air pollution on the pathway to educational attainment. For the first time we will use pollution levels at both the child's home and school using novel data linkage methods. We will use data about their home type and age that may change the amount of air pollution the child breathes, acknowledging that children spend time indoors. We will also data link to other members of their household to investigate if they live with smokers.We will use data about the individual child, for example, if each is eligible for free school meals. This will help to take into account if the child comes from a home that earns a low wage, so removing the possibility that our study will simply find known differences due to deprivation. We will also include the child's week of birth and gender. The statistical methods we use will allow us to study children from many different schools even though there are systematic differences between schools resulting in different outcomes. Including as much information that we have using characteristics about the school, such as deprivation, gender mix and overall attendance levels, will let us know how much each of these factors affects our educational outcome.Our current feasibility study will use home and school air pollution levels to include changes for children living in different streets; we will restrict our analyses to use air pollution and pollen summaries for the critical pre-examination period only. That is, we will analyse only the short-term effect of air pollution and pollen on educational attainment. We will evaluate if increased air pollution and pollen in the critical pre-exam period is associated with changes in exam results in susceptible individuals. During a workshop towards the end of this feasibility study, the team and stakeholders will assess the data needed to create a dataset to analyse the long-term effects of exposure to different levels of air pollution and pollen, beginning with mother-child pairs and the mother's educational attainment, including with the environment to which the mother is exposed during pregnancy.Keywords: Air pollution, pollen and asthma, hayfever, educational attainment