Abstract
Chronic particulate matter less than 2.5μm in diameter (PM2.5) exposure can leave infants more susceptible to illness. Our objective is to estimate associations of the chronic PM2.5 exposure with infant bronchiolitis and otitis media (OM) clinical encounters. We obtained all first time bronchiolitis (n=18,029) and OM (n=40,042) clinical encounters among children less than 12 and 36 months of age, respectively, diagnosed from 2001 to 2009 and two controls per case matched on birthdate and gestational age from the Pregnancy to Early Life Longitudinal data linkage system in Massachusetts. We applied conditional logistic regression to estimate odds ratios (OR) and confidence intervals (CI) per 2-μg/m3 increase in lifetime average satellite based PM2.5 exposure. Effect modification was assessed by age, gestational age, frequency of clinical encounter, and income. We examined associations between residential distance to roadways, traffic density, and infant bronchiolitis and OM risk. PM2.5 was not associated with infant bronchiolitis (OR=1.02, 95% CI=1.00, 1.04) and inversely associated with OM (OR=0.97, 95% CI=0.95, 0.99). There was no evidence of effect modification. Compared to infants living near low traffic density, infants residing in high traffic density had elevated risk of bronchiolitis (OR=1.23, 95% CI=1.14, 1.31) but not OM (OR=0.98, 95% CI=0.93, 1.02) clinical encounter. We did not find strong evidence to support an association between early-life long-term PM2.5 exposure and infant bronchiolitis or OM. Bronchiolitis risk was increased among infants living near high traffic density.
Highlights
Infant bronchiolitis is a lower respiratory tract infection and the leading cause of hospitalizations among children during the first year of life (Koehoorn et al, 2008)
In our analysis modeling the number of clinical encounters experienced for each child, we found no significant association between PM2.5 exposure and the rate of bronchiolitis
We found a positive association with traffic density near the home and bronchiolitis, but not with Otitis media (OM) (Table 5)
Summary
Infant bronchiolitis is a lower respiratory tract infection and the leading cause of hospitalizations among children during the first year of life (Koehoorn et al, 2008). Most bronchiolitis cases are caused by viral infection, respiratory syncytial virus (RSV) infection. Infants experience mild symptoms whereas others are hospitalized (Bacharier et al, 2012). Otitis media (OM), or inflammation of the middle ear, is one of the most frequent infections among children less than 3 years of age (Rovers et al, 2004), the most common cause for medical care besides a healthy child visit, and a major cause for antibiotic use within the first few years of life (Teele et al, 1989). OM can be caused by viral and bacterial infections. OM results from a complex combination of pathogens, environmental exposures (such as tobacco smoke and indoor wood burning), and heredity (Costa et al, 2004; Daigler et al, 1991; DiFranza et al, 2004)
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