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Short-term effects of air pollution on childhood respiratory symptoms in general practice: a time-series analysis
Mata Sabine Fonderson1, Evelien R van Meel2, Saskia Willers3
1General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, Zuid-Holland, The Netherlands M.FONDERSON@ERASMUSMC.NL.
Insights
Air pollution impacts children's respiratory health differently. While nitrogen dioxide may decrease some consultations, ozone and particulate matter (PM2.5, PM10) increase risks for specific conditions like asthma and acute upper respiratory infections.
Area of Science:
- Environmental Health
- Pediatric Respiratory Medicine
- Epidemiology
Background:
- Air pollution is a significant environmental factor affecting public health.
- Understanding the specific impacts of different air pollutants on pediatric respiratory consultations is crucial for targeted interventions.
Purpose of the Study:
- To investigate the association between daily concentrations of key air pollutants and general practitioner (GP) consultations for respiratory problems in children.
- To analyze pollutant-specific effects on various respiratory conditions in pediatric populations.
Main Methods:
- A time-series study was conducted using data from general practices in greater Rotterdam, Netherlands.
- Data included daily concentrations of nitrogen dioxide (NO2), ozone (O3), PM2.5, and PM10 at GP addresses for children aged 0-17 years.
- Relative risks of respiratory consultations were calculated, adjusted for seasonality, pollen, day of the week, and temperature.
Main Results:
- Over 100,000 consultations were analyzed between 2015 and 2019.
- Nitrogen dioxide (NO2) exposure was associated with decreased GP consultations for all respiratory diseases (ARD), acute upper respiratory infections (AURIs), and asthma, but increased consultations for cough.
- Ozone (O3) exposure showed a statistically significant increase in risk for ARD. Particulate matter (PM2.5 and PM10) exhibited varied effects, increasing risks for AURI, asthma, and cough while decreasing risks for ARD.
Conclusions:
- Air quality paradoxes exist: 'good' air quality days may still pose risks, with pollutant-specific effects differing from overall trends.
- High ozone (O3) increases total respiratory visits, while particulate matter (PM) exacerbates specific conditions like AURIs and asthma.
- Comprehensive air quality policies must consider pollutant-specific impacts on pediatric respiratory health rather than assuming uniform effects.
Objective:
To study the association between air pollutant concentrations and daily general practitioner (GP) consultations for respiratory problems in children in Rotterdam, Netherlands.
Design:
A time-series study.
Setting:
General practices in greater Rotterdam.
Patients:
Children aged 0-17 years registered with participating GPs.
Exposure:
Daily nitrogen dioxide (NO2), ozone (O3), particulate matter ≤2.5 µg/m3 (PM2.5) and particulate matter ≤10 µg/m3 (PM10) concentrations at GP addresses.
Main Outcomes Measured:
Relative risk of respiratory consultations per 10 µg/m3 in pollutant concentration, adjusted for seasonality, pollen, day of the week and temperature.
Results:
Over 100 000 consultations were analysed between 2015 and 2019. The baseline daily consultation rate was 18.12 per 1000 person-years. Children consulted their GP most frequently for acute upper respiratory infections (AURIs) (4.69 consultations per 1000 person-years), followed by asthma (3.68 consultations per 1000 person-years) and cough (2.31 consultations per 1000 person-years). Our results indicated that exposure to NO2 was predominantly associated with a decreased risk of GP consultations across most lag periods for all respiratory diseases (ARD), AURIs and asthma. In contrast, exposure to NO2 was generally associated with increased risk of GP consultations for cough. Conversely, exposure to O3 was associated with statistically significant increases in risk for ARD across all lag periods. Exposure to PM2.5 and PM10 showed opposite trends, with reduced risks in GP consultations for ARD and increased risks in consultations for AURI, asthma and cough.
Conclusions:
Our findings expose a critical paradox on the impact of air pollution. For clinicians counselling families, these results emphasise that 'good' overall air quality days may still pose risks, although effects are small. High O3 increases total respiratory visits while particulate matter, though appearing protective overall, specifically exacerbates AURIs, asthma and cough. This divergence between total and specific respiratory effects indicates that comprehensive air quality policies must consider pollutant-specific impacts rather than assuming uniform effects.
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