Early-life exposure to PM2.5 and risk of acute asthma clinical encounters among children in Massachusetts: a case-crossover analysis

Abstract

BackgroundAssociations between ambient particulate matter < 2.5 μm (PM2.5) and asthma morbidity have been suggested in previous epidemiologic studies but results are inconsistent for areas with lower PM2.5 levels. We estimated the associations between early-life short-term PM2.5 exposure and the risk of asthma or wheeze clinical encounters among Massachusetts children in the innovative Pregnancy to Early Life Longitudinal (PELL) cohort data linkage system.MethodsWe used a semi-bidirectional case-crossover study design with short-term exposure lags for asthma exacerbation using data from the PELL system. Cases included children up to 9 years of age who had a hospitalization, observational stay, or emergency department visit for asthma or wheeze between January 2001 and September 2009 (n = 33,387). Daily PM2.5 concentrations were estimated at a 4-km resolution using satellite remote sensing, land use, and meteorological data. We applied conditional logistic regression models to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CI). We also stratified by potential effect modifiers.ResultsThe median PM2.5 concentration among participants was 7.8 μg/m3 with an interquartile range of 5.9 μg/m3. Overall, associations between PM2.5 exposure and asthma clinical encounters among children at lags 0, 1 and 2 were close to the null value of OR = 1.0. Evidence of effect modification was observed by birthweight for lags 0, 1 and 2 (p < 0.05), and season of clinical encounter for lags 0 and 1 (p < 0.05). Children with low birthweight (LBW) (< 2500 g) had increased odds of having an asthma clinical encounter due to higher PM2.5 exposure for lag 1 (OR: 1.08 per interquartile range (IQR) increase in PM2.5; 95% CI: 1.01, 1.15).ConclusionAsthma or wheeze exacerbations among LBW children were associated with short-term increases in PM2.5 concentrations at low levels in Massachusetts.Electronic supplementary materialThe online version of this article (10.1186/s12940-018-0361-6) contains supplementary material, which is available to authorized users.

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“…PM 2.5 represents the fine particulate matter with aerodynamic diameter of 2.5 μm or less, deriving from vehicular exhaust, fuel burning and some industrial activities [6,7]. Short-term and long-term exposure to PM 2.5 can cause a variety of adverse health outcomes, such as increased morbidity and mortality relating to both cardiovascular and respiratory diseases [4,8,9,10].…”

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