Delfino Ralph J, Chang Joyce, Wu Jun, Ren Cizao, Tjoa Thomas, Nickerson Bruce, Cooper Dan, Gillen Daniel L
Department of Epidemiology, School of Medicine, University of California, Irvine 92617-7555, USA.
Ann Allergy Asthma Immunol. 2009 Feb;102(2):138-44. doi: 10.1016/S1081-1206(10)60244-X.
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.
To estimate the association of local traffic-generated air pollution with repeated hospital encounters for asthma in children.
Hospital records for 2,768 children aged 0 to 18 years (697 of whom had > or = 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.
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.
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.
哮喘的医院总诊疗次数（住院或急诊就诊）与每日区域空气污染有关。关于反复住院诊疗次数与家庭附近交通相关空气污染之间关系的数据较少。
评估当地交通产生的空气污染与儿童哮喘反复住院诊疗次数之间的关联。
获取了加利福尼亚州橙县北部两家医院集水区内2768名0至18岁儿童的医院记录（其中697名儿童有≥2次诊疗经历）。对居住地址进行了地理编码。使用线源扩散模型从首次住院诊疗开始纵向估计个体季节性接触当地交通产生的污染物（氮氧化物和一氧化碳）的情况。采用复发比例风险分析来估计空气污染暴露风险，并对性别、年龄、健康保险、人口普查得出的贫困状况、种族/族裔、住所与医院的距离以及季节进行了调整。对调整变量和人口普查得出的家庭收入中位数进行了效应修正检验。
氮氧化物（4.00 ppb）和一氧化碳（0.056 ppm）四分位间距增加时的调整风险比分别为1.10（95%置信区间，1.03 - 1.16）和1.07（1.01 - 1.14）。女孩和婴儿的关联最强，但与其他组无显著差异。高收入街区组儿童的关联更强（趋势P < 0.09），这可能是由于数据更准确。
反复住院诊疗次数的关联表明，家庭附近当地产生的空气污染会影响儿童哮喘的严重程度。风险可能始于婴儿期，并在儿童后期持续存在，此时哮喘诊断更为明确。
