Medical record review of acute childhood wheeze presentations, air pollution and deprivation

Abstract

<b>Background and aims:</b> The impact air pollution and deprivation have on acute childhood wheeze (asthma and viral-induced wheeze (VIW)) presentations is poorly understood, especially in preschool children. We aimed to describe demographics, clinical outcomes and social characteristics of children presenting with acute wheeze in Liverpool, UK (population: 498,000 in 2019). <b>Methods:</b> A retrospective observational study of children aged 2-16 years hospitalised with VIW or asthma over 5 years, between 1/9/2015 and 31/8/2020, was undertaken. Data collected included demographics, severity indicators and social characteristics (Index of Multiple Deprivation (IMD) decile and estimated mean local monthly nitrogen dioxide (NO₂) exposure). <b>Results:</b> There were 4263 admissions, with more males (64.3%) and 2–6-year-olds (73.5%). 58% (n=2466) of admissions were from the most deprived IMD decile (IMD1) and 0.2% (n=8) from the least deprived (IMD10). Median length of stay of IMD 1 patients was longer than less deprived deciles (p&lt;0.0001). No children from the least deprived areas (IMD 8-10, n=174) were admitted to critical care. There was a non-significant positive correlation (Spearman’s Correlation Coefficient – 0.137, p=0.33 CI - 0.15 to 0.40) between mean NO₂ concentration and number of admissions.&nbsp;59% (n=1423) of admissions were associated with estimated NO₂ exposure exceeding WHO guidelines (annual mean of 40μg/m³) and 12% (n=298) had exposure over 60μg/m³. <b>Conclusion:</b> Here, we describe the extent of NO₂ air pollution and deprivation in Liverpool, and their association with paediatric respiratory health. More research is needed to fully elucidate these relationships and to measure the effect of interventions.