Satellite-based estimates of ambient air pollution and global variations in childhood asthma prevalence Anderson, H. Ross; Butland, Barbara K.; van Donkelaar, Aaron; Brauer, Michael; Strachan, David P.; Clayton, Tadd; van Dingenen, Rita; Amann, Marcus; Brunekreef, Bert; Cohen, Aaron; Dentener, Frank; Lai, Christopher; Lamsal, Lok N.; Martin, Randall V.; ISAAC Phase One study group; ISAAC Phase Three study group
Background: The effect of ambient air pollution on global variations and trends in asthma prevalence is unclear. Objectives: Our goal was to investigate community-level associations between asthma prevalence data from the International Study of Asthma and Allergies in Childhood (ISAAC) and satellite-based estimates of particulate matter with aerodynamic diameter < 2.5 μm (PM₂.₅) and nitrogen dioxide (NO₂), and modelled estimates of ozone. Methods: We assigned satellite-based estimates of PM₂.₅ and NO₂ at a spatial resolution of 0.1° × 0.1° and modeled estimates of ozone at a resolution of 1° × 1° to 183 ISAAC centers. We used center-level prevalence of severe asthma as the outcome and multilevel models to adjust for gross national income (GNI) and center- and country-level sex, climate, and population density. We examined associations (adjusting for GNI) between air pollution and asthma prevalence over time in centers with data from ISAAC Phase One (mid-1900s) and Phase Three (2001–2003). Results: For the 13- to 14-year age group (128 centers in 28 countries), the estimated average within-country change in center-level asthma prevalence per 100 children per 10% increase in center-level PM₂.₅ and NO₂ was –0.043 [95% confidence interval (CI): –0.139, 0.053] and 0.017 (95% CI: –0.030, 0.064) respectively. For ozone the estimated change in prevalence per parts per billion by volume was –0.116 (95% CI: –0.234, 0.001). Equivalent results for the 6- to 7‑year age group (83 centers in 20 countries), though slightly different, were not significantly positive. For the 13- to 14‑year age group, change in center-level asthma prevalence over time per 100 children per 10% increase in PM₂.₅ from Phase One to Phase Three was –0.139 (95% CI: –0.347, 0.068). The corresponding association with ozone (per ppbV) was –0.171 (95% CI: –0.275, –0.067). Conclusion: In contrast to reports from within-community studies of individuals exposed to traffic pollution, we did not find evidence of a positive association between ambient air pollution and asthma prevalence as measured at the community level.
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