Harmful Effects of Ambient Nitrogen Dioxide on Atopic Dermatitis: Comparison of Exposure Assessment Based on Monitored Concentrations and Modeled Estimates

Abstract

Precise exposure assessment of air pollutants is crucial in epidemiologic studies to ensure valid estimates of health effects. We conducted a longitudinal study to evaluate the role of air quality monitoring (AQM) measurements and high-resolution modeling outcomes focusing on nitrogen dioxide (NO2) exposure and atopic dermatitis (AD). A total of 128 young children with AD in Seoul Metropolitan Area, Korea, were recruited as a panel. We estimated the participants’ exposure to NO2 for four months, from 1 April through 31 July 2014 based on (1) monitored levels from 60 AQM stations located at varying distances from residential areas (AQM station-based NO2, AQM-NO2) and (2) estimates from a community multi-scale air quality (CMAQ) modeling system with a high-resolution (1 × 1 km) (CMAQ-NO2). We then compared the effect of AQM-NO2 on AD symptoms with that of CMAQ-NO2. The average distance between the participants’ residences and the nearest AQM station was 2.03 ± 1.06 km, ranging from 0.28 km to 5.73 km. Based on AQM-NO2, the AD symptoms increased by 10.28% (95% confidence interval (CI): 3.24, 17.79) with an increase of 10 ppb of NO2. The effect estimates of CMAQ-NO2 were similar to those of AQM-NO2 when assessed in patients living within 3 km from the nearest AQM station. Even within 1 km, the CI estimate obtained from the CMAQ was much narrower than from AQM (44.18–49.54 vs. 7.02–64.75). However, the association of AQM-NO2 with AD symptoms of patients living beyond 3 km was not positive, whereas that of CMAQ-NO2 maintained positive. In conclusion, exposure to ambient NO2 is significantly associated with aggravation of AD symptoms in young children. In addition, our study suggests that exposure assessment of NO2 using measurement data obtained from monitoring stations far from residential locations can lead to misclassification bias.