主要道路的临近与学校内城哮喘研究中的哮喘症状。
Proximity to major roadways and asthma symptoms in the School Inner-City Asthma Study.
机构信息
Division of General Pediatrics, Boston Children's Hospital, Boston, Mass; Region 1 New England Pediatric Environmental Health Specialty Unit, Boston, Mass; Harvard Medical School, Boston, Mass.
Harvard Medical School, Boston, Mass; Division of Respiratory Diseases, Boston Children's Hospital, Boston, Mass.
出版信息
J Allergy Clin Immunol. 2020 Jan;145(1):119-126.e4. doi: 10.1016/j.jaci.2019.08.038. Epub 2019 Sep 23.
BACKGROUND
Traffic proximity has been associated with adverse respiratory health outcomes. Less is known about the combined impact of residential and school exposures on pediatric asthma.
OBJECTIVE
We sought to use spatial analysis methodology to analyze residential and school proximity to major roadways and pediatric asthma morbidity.
METHODS
The School Inner-City Asthma Study (n = 350) recruited school-aged children with asthma. Each participant's school and home addresses were geocoded, and distances from major roadways were measured to calculate a composite measure accounting for both home and school traffic exposure. Generalized estimating equation models were clustered by subject and adjusted for age, race/ethnicity, sex, income, environmental tobacco smoke, controller medication, upper respiratory tract infections, and seasonality.
RESULTS
The majority of participants (62%) attended schools within 100 m from major roadways, and 40% also resided within 100 m of major roadways. In multivariate analyses major roadway proximity was independently associated with increased asthma symptom days. At greater than the threshold of 100 m, children had 29% less odds of a symptom day over the past 2 weeks for each 100-m increase in distance from a major roadway (odds ratio, 0.71; 95% CI, 0.58-0.87; P < .01). Children farther from a major roadway also had significantly less reported health care use (odds ratio, 0.63; 95% CI, 0.47-0.85; P < .01) and were significantly less likely to have poor asthma control (odds ratio, 0.80; 95% CI, 0.69-0.94; P < .01). There was not a meaningful association between distance to a major roadway and lung function outcomes.
CONCLUSIONS
Proximity to a major roadway, a composite measure of home and school exposure but primarily driven by home exposure, was associated with greater asthma morbidity. More studies are needed to evaluate the independent effect of school distance to a roadway on asthma morbidity.
背景
交通接近度与不良呼吸健康结果有关。对于居住和学校暴露对儿童哮喘的综合影响，人们了解较少。
目的
我们试图使用空间分析方法分析住宅和学校与主要道路的接近程度以及儿科哮喘发病率。
方法
城市学校哮喘研究（n=350）招募了患有哮喘的学龄儿童。每位参与者的学校和家庭住址均经过地理编码，并测量了与主要道路的距离，以计算一个综合指标，该指标同时考虑了家庭和学校的交通暴露。广义估计方程模型按主题进行聚类，并根据年龄、种族/族裔、性别、收入、环境烟草烟雾、控制器药物、上呼吸道感染和季节性进行调整。
结果
大多数参与者（62%）就读于距离主要道路 100 m 以内的学校，40%的参与者也居住在距离主要道路 100 m 以内的地方。在多变量分析中，主要道路接近度与哮喘症状天数的增加独立相关。在超过 100 m 的阈值时，距离主要道路每增加 100 m，儿童在过去 2 周内出现症状日的几率就会降低 29%（优势比，0.71；95%置信区间，0.58-0.87；P<0.01）。距离主要道路较远的儿童报告的医疗保健使用也明显减少（优势比，0.63；95%置信区间，0.47-0.85；P<0.01），并且哮喘控制不佳的可能性也明显降低（优势比，0.80；95%置信区间，0.69-0.94；P<0.01）。主要道路距离与肺功能结果之间没有有意义的关联。
结论
主要道路的接近度是家庭和学校暴露的综合指标，但主要受家庭暴露的驱动，与更高的哮喘发病率有关。需要进一步研究来评估学校到道路的距离对哮喘发病率的独立影响。
Zotero 插件