Abstract
BackgroundThere is growing evidence suggesting that air pollution may act as an important environmental risk factor in the development and aggravation of childhood atopic dermatitis (AD).MethodsWe collected data from the Taiwan National Health Insurance (NHI) research database and linked the data to the Taiwan Air Quality-Monitoring Database. From January 1, 2000 to December 31, 2012; children aged below 18 years were selected from the database and followed longitudinally until the diagnosis of AD, withdrawal from the NHI, or December 31, 2012. Children with missing data or those diagnosed with AD before enrolment in this study were excluded. We measured the incidence rate and hazard ratios (HRs) for AD and stratified them by quartiles (Q1–Q4) of air pollutant concentration. Multivariable Cox proportional hazards models were also applied by adjusting for age, sex, monthly income, and level of urbanization.ResultsWhen compared with the concentrations of pollutants in the Q1 quartile, the adjusted HR for AD increased with an increase in the exposure concentrations of total hydrocarbons (THCs), non-methane hydrocarbons (NMHCs), and methane (CH4) from 1.65 (95% confidence interval [CI]: 1.47–1.84) to 10.6 (95% CI: 5.85–7.07), from 1.14 (95% CI: 1.06–1.24) to 2.47 (95% CI: 2.29–2.66), and from 1.70 (95% CI: 1.52–1.89) to 11.9 (95% CI: 10.8–13.1), respectively. Patients exposed to higher levels of THCs, NMHCs, and CH4 exhibited greater incidence rates of childhood AD.ConclusionsThe present study demonstrated that exposure to higher concentrations of THCs, NMHCs, and CH4 were associated with an increased risk of childhood AD.
Highlights
There is growing evidence suggesting that air pollution may act as an important environmental risk factor in the development and aggravation of childhood atopic dermatitis (AD)
We focused on the association between hydrocarbons and the development of childhood AD
We collected the data of participants under conditions of total hydrocarbons (THCs), non-methane hydrocarbons (NMHCs), and CH4 exposure based on the location of the Taiwan Air Quality Monitoring station
Summary
Data source We conducted a retrospective cohort study using the Children’s File, a representative database including data from half of all children randomly selected from the registry of beneficiaries of the Taiwan National Health Insurance (NHI) Research Database (NHIRD) for the year 2000. The NHIRD was established in 1995 and covers more than 99% of the total population in Taiwan [21] It contains all medical records including deidentified demographic information such as sex, birth dates, occupation of the beneficiaries, and place of residence and clinical information such as diagnostic codes based on the International Classification of Disease, 9th Revision, Clinical Modification [ICD-9-CM] [22]; health management; and treatment. We linked the NHIRD and the TAQMD data according to the residential areas of candidates and the location of air quality-monitoring stations. Statistical analysis The demographic data in our study included age, sex, monthly income, level of residential urbanization, and daily average exposure to air pollutants. The chi-squared test was used to analyze the distributed difference among daily average concentrations for each air pollutant by quartile and urbanization. The incidence rate of AD (per 1000 person-years) was calculated at four different air pollutant concentration levels. The significance level was set at p < 0.05 in all statistical tests
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