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Long-term exposure to outdoor air pollution and the prevalence of asthma: meta-analysis of multi-community prevalence studies

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Abstract

The effect of outdoor air pollution on variations in asthma prevalence is unclear. We have conducted a meta-analysis of multi-community studies to evaluate and quantify the evidence for an association between community levels of pollution and asthma prevalence. We identified peer-reviewed articles reporting associations between community levels of air pollution and the prevalence of wheeze symptom or asthma diagnosis which were based on five or more communities. Associations were investigated by meta-analysis and by analysis of the direction and statistical significance of estimates. We identified 21 studies of more than five communities (range 6 to 62). The proportion of studies reporting at least one significantly positive association was 43% but, of the total of 178 pollution-outcome estimates, only 11% were statistically significantly positive. Thirteen studies reported associations with pollution analysed as a quantitative variable, and these results were meta-analysed. For period prevalence (mainly wheeze symptom), the results were null: Random effects estimates (95% confidence intervals) for the odds ratios of nitrogen dioxide, particulate matter with aerodynamic diameter <10 μm, ozone and sulphur dioxide were 1.00 (0.95, 1.06), 1.00 (0.94, 1.07), 1.01 (0.96, 1.07) and 1.03 (0.97, 1.09), respectively. For lifetime prevalence (mainly asthma diagnosis), the random effects estimates were similar: 1.00 (0.99, 1.01), 0.99 (0.96, 1.02), 1.06 (0.98, 1.14) and 1.00 (0.96, 1.05), respectively. We found no evidence of an association between community levels of outdoor air pollution and asthma prevalence.

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References

  • Anderson HR, Gupta R, Kapetanakis V, Asher MI, Clayton T, Robertson CF, Strachan DP (2008) International correlations between indicators of prevalence, hospital admissions and mortality for asthma in children. Int J Epidemiol 37:573–582

    Article  CAS  Google Scholar 

  • Anderson HR, Ruggles R, Pandey KD, Kapetanakis V, Brunekreef B, Lai CKW, Strachan DP, Weiland SK (2010) Ambient particulate pollution and the world-wide prevalence of asthma, rhinoconjunctivitis and eczema in children: phase one of the International Study of Asthma and Allergies in Childhood (ISAAC). Occup Environ Med 67:293–300

    Article  Google Scholar 

  • Annesi-Maesano I, Moreau D, Caillaud D, Lavaud F, Le MY, Taytard A, Pauli G, Charpin D (2007) Residential proximity fine particles related to allergic sensitisation and asthma in primary school children. Respir Med 101:1721–1729

    Article  Google Scholar 

  • Armstrong BG (1998) Effect of measurement error on epidemiological studies of environmental and occupational exposures. Occup Environ Med 55:651–656

    Article  CAS  Google Scholar 

  • Asher MI, Stewart AW, Mallol J, Montefort S, Lai CK, it-Khaled N, Odhiambo J (2010) Which population level environmental factors are associated with asthma, rhinoconjunctivitis and eczema? Review of the ecological analyses of ISAAC Phase One. Respir Res 11:8

    Article  Google Scholar 

  • Baldi I, Tessier JF, Kauffmann F, Jacqmin-Gadda H, Nejjari C, Salamon R (1999) Prevalence of asthma and mean levels of air pollution: results from the French PAARC survey. Eur Respir J 14:132–138

    Article  CAS  Google Scholar 

  • Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50:1088–1101

    Article  CAS  Google Scholar 

  • Braun-Fahrlander C, Vuille JC, Sennhauser FH, Neu U, Kunzle T, Grize L, Gassner M, Minder C, Schindler C, Varonier HS, Wuthrich B (1997) Respiratory health and long-term exposure to air pollutants in Swiss schoolchildren. SCARPOL Team. Swiss study on childhood allergy and respiratory symptoms with respect to air pollution, climate and pollen. Am J Respir Crit Care Med 155:1042–1049

    CAS  Google Scholar 

  • Chen PC, Lai YM, Wang JD, Yang CY, Hwang JS, Kuo HW, Huang SL, Chan CC (1998) Adverse effect of air pollution on respiratory health of primary school children in Taiwan. Environ Health Perspect 106:331–335

    Article  CAS  Google Scholar 

  • de Marco R, Poli A, Ferrari M, Accordini S, Giammanco G, Bugiani M, Villani S, Ponzio M, Bono R, Carrozzi L, Cavallini R, Cazzoletti L, Dallari R, Ginesu F, Lauriola P, Mandrioli P, Perfetti L, Pignato S, Pirina P, Struzzo P (2002) The impact of climate and traffic-related NO2 on the prevalence of asthma and allergic rhinitis in Italy. Clin Exp Allergy 32:1405–1412

    Article  Google Scholar 

  • Department of Health Committee on the Medical Effects of Air Pollutants (1995) Asthma and outdoor air pollution. HMSO, London

    Google Scholar 

  • DerSimonian R, Laird NM (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

    Article  CAS  Google Scholar 

  • Dockery DW, Cunningham J, Damokosh AI, Neas LM, Spengler JD, Koutrakis P, Ware JH, Raizenne M, Speizer FE (1996) Health effects of acid aerosols on North American children: respiratory symptoms. Environ Health Perspect 104:500–505

    Article  CAS  Google Scholar 

  • Dockery DW, Speizer FE, Stram DO, Ware JH, Spengler JD, Ferris BG Jr (1989) Effects of inhalable particles on respiratory health of children. Am Rev Respir Dis 139:587–594

    CAS  Google Scholar 

  • Egger M, Davey SG, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634

    Article  CAS  Google Scholar 

  • Florey CD, Swan AV, Van der Lende R, Holland WW, Berlin A, Di Ferrante E (1983) Report on the EC epidemiological survey on the relationship between air pollution and respiratory health in primary schoolchildren. Commission of the European Communities, Brussels

    Google Scholar 

  • Forsberg B (1997) Prevalence of respiratory and hyperreactivity symptoms in relation to levels of criteria air pollutants in Sweden. Eur J Public Health 7:1997

    Article  Google Scholar 

  • Health Effects Institute (2010) HEI special report 17: Traffic-related air pollution: a critical review of the literature on emissions, exposure, and health effects. Health Effects Institute, Boston

    Google Scholar 

  • Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558

    Article  Google Scholar 

  • Hong SJ, Lee MS, Sohn MH, Shim JY, Han YS, Park KS, Ahn YM, Son BK, Lee HB, Korean ISAAC Study Group (2004) Self-reported prevalence and risk factors of asthma among Korean adolescents: 5-year follow-up study, 1995–2000. Clin Exp Allergy 34:1556–1562

    Article  Google Scholar 

  • Hwang BF, Lee YL, Lin YC, Jaakkola JJ, Guo YL (2005) Traffic related air pollution as a determinant of asthma among Taiwanese school children. Thorax 60:467–473

    Article  Google Scholar 

  • Janssen NA, Brunekreef B, Van VP, Aarts F, Meliefste K, Harssema H, Fischer P (2003) The relationship between air pollution from heavy traffic and allergic sensitization, bronchial hyperresponsiveness, and respiratory symptoms in Dutch schoolchildren. Environ Health Perspect 111:1512–1518

    Article  Google Scholar 

  • Kelly FJ (2003) Oxidative stress: its role in air pollution and adverse health effects. Occup Environ Med 60:612–616

    Article  Google Scholar 

  • Lai CK, Beasley R, Crane J, Foliaki S, Shah J, Weiland S (2009) Global variation in the prevalence and severity of asthma symptoms: phase three of the International Study of Asthma and Allergies in Childhood (ISAAC). Thorax 64:476–483

    Article  CAS  Google Scholar 

  • Liebhart J, Malolepszy J, Wojtyniak B, Pisiewicz K, Plusa T, Gladysz U (2007) Prevalence and risk factors for asthma in Poland: results from the PMSEAD study. J Investig Allergol Clin Immunol 17:367–374

    CAS  Google Scholar 

  • Pattenden S, Hoek G, Braun-Fahrlander C, Forastiere F, Kosheleva A, Neuberger M, Fletcher T (2006) NO2 and children's respiratory symptoms in the PATY study. Occup Environ Med 63:828–835

    Article  CAS  Google Scholar 

  • Penard-Morand C, Charpin D, Raherison C, Kopferschmitt C, Caillaud D, Lavaud F, Annesi-Maesano I (2005) Long-term exposure to background air pollution related to respiratory and allergic health in schoolchildren. Clin Exp Allergy 35:1279–1287

    Article  CAS  Google Scholar 

  • Peters JM, Avol E, Navidi W, London SJ, Gauderman WJ, Lurmann F, Linn WS, Margolis H, Rappaport E, Gong H, Thomas DC (1999) A study of twelve Southern California communities with differing levels and types of air pollution. I. Prevalence of respiratory morbidity. Am J Respir Crit Care Med 159:760–767

    CAS  Google Scholar 

  • Pope CA III, Dockery DW (2006) Health effects of fine particulate air pollution: lines that connect. J Air Waste Manage Assoc 56:709–742

    Article  CAS  Google Scholar 

  • Shima M, Adachi M (2000) Effect of outdoor and indoor nitrogen dioxide on respiratory symptoms in schoolchildren. Int J Epidemiol 29:862–870

    Article  CAS  Google Scholar 

  • Shima M, Nitta Y, Ando M, Adachi M (2002) Effects of air pollution on the prevalence and incidence of asthma in children. Arch Environ Health 57:529–535

    Article  CAS  Google Scholar 

  • Solomon C, Poole J, Jarup L, Palmer K, Coggon D (2003) Cardio-respiratory morbidity and long-term exposure to particulate air pollution. Int J Environ Health Res 13:327–335

    Article  CAS  Google Scholar 

  • Stata Corporation (2007) STATA/SE 10.1 statistics/data analysis. Stata Corporation, College Station

    Google Scholar 

  • Sterne JA, Gavaghan D, Egger M (2000) Publication and related bias in meta-analysis: power of statistical tests and prevalence in the literature. J Clin Epidemiol 53:1119–1129

    Article  CAS  Google Scholar 

  • Wang TN, Ko YC, Chao YY, Huang CC, Lin RS (1999) Association between indoor and outdoor air pollution and adolescent asthma from 1995 to 1996 in Taiwan. Environ Res 81:239–247

    Article  CAS  Google Scholar 

  • WHO European Centre for Environment and Health (2005) Effects of air pollution on children's health and development—a review of the evidence. WHO Regional Office for Europe, Bonn

    Google Scholar 

  • Wilson D, Takahashi K, Pan G, Chan CC, Zhang S, Feng Y, Hoshuyama T, Chuang KJ, Lin RT, Hwang JS (2008) Respiratory symptoms among residents of a heavy-industry province in China: prevalence and risk factors. Respir Med 102:1536–1544

    Article  Google Scholar 

  • World Health Organisation (1980) Study on chronic respiratory diseases in children in relation to air pollution. WHO, Geneva

    Google Scholar 

  • World Health Organisation (2006) Air quality guidelines: global update 2005, particulate matter, ozone, nitrogen dioxide and sulphur dioxide. WHO Regional Office for Europe, Copenhagen

    Google Scholar 

  • Zemp E (1999) Long-term ambient air pollution and respiratory symptoms in adults (SAPALDIA Study). Am J Respir Crit Care Med 159:1257–1266

    CAS  Google Scholar 

  • Zhang JF, Hu W, Wei FS, Wu GP, Korn LR, Chapman RS (2002) Children's respiratory morbidity prevalence in relation to air pollution in four Chinese cities. Environ Health Perspect 110:961–967

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We gratefully acknowledge the support of Mary Field-Smith in the preparation of the paper for publication and the encouragement of the Health Protection Agency Air Quality Unit (Head: Professor Robert Maynard) in developing this study.

The study was funded by the Policy Research Unit of the UK Department of Health. The views expressed in this paper are those of the authors alone and do not necessarily reflect those of the Department of Health.

Competing interests

The authors declare that they have no competing interests.

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Authors and Affiliations

  1. MRC-HPA Centre for Environment and Health, Division of Population Health Sciences and Education, St George’s, University of London, Cranmer Terrace, London, SW17 0RE, UK

    H. Ross Anderson, Graziella Favarato & Richard W. Atkinson

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  1. H. Ross Anderson
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  2. Graziella Favarato
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  3. Richard W. Atkinson
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Correspondence to H. Ross Anderson.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Online Resource 1

Key words, flow chart for literature and protocols for selection of articles (PDF 35 kb)

Online Resource 2

Conversions and scaling (PDF 58 kb)

Online Resource 3

Algorithms and rules for selecting estimates for meta-analyses (PDF 55 kb)

Online Resource 4

Summary of multi-community studies reporting quantitative associations between outdoor air pollution and asthma (PDF 36 kb)

Online Resource 5

Summary of multi-community prevalence studies reporting qualitative associations between outdoor air pollution and asthma (PDF 69 kb)

Online Resource 6

Details of estimates for quantitative studies (PDF 143 kb)

Online Resource 7

Details of estimates for qualitative studies (PDF 86 kb)

Online Resource 8

Analysis of estimates by direction and statistical significance (PDF 62 kb)

Online Resource 9

Meta-analysis plots of associations between community levels of NO2, PM10, O3, SO2 and lifetime prevalence of asthma (PDF 81 kb)

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Anderson, H.R., Favarato, G. & Atkinson, R.W. Long-term exposure to outdoor air pollution and the prevalence of asthma: meta-analysis of multi-community prevalence studies. Air Qual Atmos Health 6, 57–68 (2013). https://doi.org/10.1007/s11869-011-0145-4

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  • DOI: https://doi.org/10.1007/s11869-011-0145-4

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