Adverse Effects Of Air Pollution Research Articles

Proteomic changes driven by urban pollution suggest particulate matter as a deregulator of energy metabolism, mitochondrial activity, and oxidative pathways in the rat brain

The adverse effects of air pollution have been long studied in the lung and respiratory systems, but the molecular changes that this causes at the central nervous system level have yet to be fully investigated and understood. To explore the evolution with time of protein expression levels in the brain of rats exposed to particulate matter of different sizes, we carried out two-dimensional gel electrophoresis followed by determination of dysregulated proteins through Coomassie blue staining-based densities (SameSpots software) and subsequent protein identification using MALDI-based mass spectrometry. Expression differences in dysregulated proteins were found to be statistically significant with p-value <0.05. A systems biology-based approach was utilized to determine critical biochemical pathways involved in the rats' brain response. Our results suggest that rats' brains have a particulate matter size dependent-response, being the mitochondrial activity and the astrocyte function severely affected. Our proteomic study confirms the dysregulation of different biochemical pathways involving energy metabolism, mitochondrial activity, and oxidative pathways as some of the main effects of PM exposure on the rat brain. SignificanceRat brains exposed to particulate matter with origin in car engines are affected in two main areas: mitochondrial activity, by the dysregulation of many pathways linked to the respiratory chain, and neuronal and astrocytic function, which stimulates brain changes triggering tumorigenesis and neurodegeneration.

Population susceptibility differences and effects of air pollution on cardiovascular mortality: epidemiological evidence from a time-series study.

There is insufficient evidence on the relationship between air pollution and mortality from cardiovascular disease (CVD) in northeast China. Here, we explored the short-term effects of air pollution on CVD mortality and preliminarily investigated differences in population susceptibility to air pollution in Shenyang, China. CVD mortality, air pollution, and meteorological data during 2013-2016 were obtained. Time-series analysis was applied to evaluate the association between air pollution and daily CVD mortality with different lag structures. In the single-pollutant model, each 10μg/m3 increase in PM2.5, PM10, SO2, NO2, and O3 concentrations and 1mg/m3 increase in CO concentrations at lag0 (same day) was significantly associated with an increase of 0.40% (95% confidence interval, 0.22-0.59%), 0.26% (0.12-0.40%), 0.43% (0.16-0.70%), 0.90% (0.14-1.67%), 0.76% (0.21-1.32%), and 3.33% (0.97-5.75%), respectively, in overall CVD mortality. Susceptibility to air pollutants was higher among females, elderly people, and ischemic heart disease patients. Furthermore, air pollution effects on CVD mortality were 2-8 times greater during the non-heating period. In conclusion, the air pollutants PM2.5, PM10, SO2, NO2, O3, and CO showed significant positive effects on CVD mortality in Shenyang, China. These findings highlight the adverse effects of air pollution and suggest the need for personal protective equipment and reduction of air pollution sources.

THE IMPROVEMENT OF APPROACHES TO THE ASSESSMENT OF EFFECTS OF THE ANTHROPOGENIC AIR POLLUTION ON THE POPULATION IN ORDER TO MANAGEMENT THE RISK FOR HEALTH

The air pollution has got a great risk to the health of the population. In the risk assessment, objective and subjective uncertainties have appeared. The aim of the study to analyze the uncertainties arising in the assessment of health adverse effects of air pollution and possible ways to decrease them. Methods of the scientific hypothetical deductive cognition, general logical methods, and approaches of researches: analysis, synthesis, abstracting, generalization, induction. In this paper, we analyzed the uncertainties arising in the risk assessment for the health of population caused by air pollution and proposed measures to improve the approaches to assessment and management of the risk. The analysis revealed the main causes of the uncertainties. In the field of the atmospheric air monitoring, they are lack of modern equipment and officially approved methods for measurement, the absence of criteria and recommendation for choosing of controlled air pollutants. For the health assessment, it is advisable to use epidemiological methods and methodology of risk analysis taking into account the uncertainties of each approach. Usage of the geographic information systems let increase the informativity of data and efficiency of analysis. Accurate quantification of the risk for the health of population caused by air pollution is a difficult to challenge. It is necessary to take into account the experience of developed countries in the development of domestic criteria for the selection of substances for the control of atmospheric air quality. It is advisable to combine the analysis of data on the actual concentrations of pollutants obtained at stationary and mobile observation posts, and integrated calculations of air pollution. It is necessary to use basic concepts of evidence-based medicine to identify the real impact of air pollutants on public health and reduce uncertainties. Conclusion. In the assessment of risk for health caused by air pollution a lot of objective and subjective uncertainties appear. Based on the principles of evidence-based medicine, they should be comprehensively analyzed and minimized using modern methodological approaches, taking into account their capabilities and limitations.

Long-Term Exposure to Air Pollution and Survival After Ischemic Stroke.

Background and Purpose- China bears a heavy burden of stroke because of its large population of elderly people and the propensity for stroke. Previous studies have examined the association between air pollution and stroke mortality or hospital admission. However, the global evidence for adverse effects of air pollution on survival after stroke is scarce. Methods- We used the first national hospital-based prospective registry cohort of stroke in China, which included 12 291 ischemic stroke patients who visited hospitals during 2007 to 2008. All patients were followed for 1-year poststroke. Deaths during the follow-up period were recorded. Participants' 3-year prestroke exposures to ambient PM1, PM2.5, PM10 (particulate matter with aerodynamic diameters ≤1, ≤2.5, and ≤10 μm, respectively) and NO2 (nitrogen dioxide) were estimated by machine learning algorithms with satellite remote sensing, land use information, and meteorological data. Cox proportional hazards models were used to examine the association between air pollution and survival after ischemic stroke. Results- In total, 1649 deaths were identified during the 1-year follow-up period. After controlling for potential confounders, significant associations were observed between exposure to PM1 and PM2.5 and incident fatal ischemic stroke. The corresponding hazard ratios and 95% CIs associated with 10 µg/m3 increase in PM1 and PM2.5 were 1.05 (1.02-1.09) and 1.03 (1.00-1.06), respectively. No significant association was observed for PM10 or NO2 (hazard ratios and 95% CIs, 1.01 [1.00-1.03] and 1.03 [0.99-1.06], respectively). Higher hazard ratios (and 95% CIs) were observed for male, elderly and obese individuals. Conclusions- Prestroke exposure to PM1 and PM2.5 was associated with increased incident fatal ischemic stroke in the year following an ischemic stroke in China. Improved air quality may be beneficial for people to recover from stroke.

Air pollution, climate change and health: from evidence to action

The adverse effects of air pollution and climate change on human health have already been a major global environmental issue, and the challenges in China are even more severe. In this issue, titled "Air Pollution Climate, Change and Health" , we present a series of articles that reviewed and analyzed the impact of air pollution and climate change on human health systematically, and propose recommendations for the next phase of research. Meanwhile, we introduce the latest achievements of the World Health Organization (WHO) in coping with air pollution and health, summarize the first WHO Global Conference on Air Pollution and Health, and provide evidence-based guidelines for control and prevention of climate change and air pollution in China.

Air Pollution During Pregnancy and Birth Outcomes in Italy

We investigate the impact of fetal exposure to air pollution on health outcomes at birth in Italy in the 2000s combining information on mother’s residential location from birth certificates with information on PM10 concentrations from air quality monitors. The potential endogeneity deriving from differential pollution exposure is addressed by exploiting as-good-as-random variation in rainfall shocks as an instrumental variable for air pollution concentrations. Our results show that both average levels of PM10 and days above the hazard limit have detrimental effects on birth weight, duration of gestation as well as overall health status at birth. These effects are mainly driven by pollution exposure during the third trimester of pregnancy and further differ in size with respect to the maternal socio-economic status, suggesting that babies born to socially disadvantaged mothers are more vulnerable. Given the non negligible effects of pollution on birth outcomes, further policy efforts are needed to fully protect fetuses from the adverse effects of air pollution and to mitigate the environmental inequality of health at birth.

Association between air pollution and type 2 diabetes: an updated review of the literature.

Air pollution and type 2 diabetes mellitus (T2DM) are critical public health issues worldwide. A large number of epidemiological studies have highlighted the adverse effects of air pollution on diabetes, and include risk profiles for different exposure durations, study design types, subgroup populations, and effects of air pollution components. We researched PubMed, Google Scholar, and Web of Science to identify studies on the association between air pollution and T2DM from January 2009 to January 2019. The aim of this review is to provide a brief overview of epidemiological and experimental studies on air pollution associated with T2DM from the latest research, which may provide practical information about this relationship and possible mechanisms. Current cumulative evidence appears to suggest that T2DM-related biomarkers increase with increasing exposure duration and concentration of air pollutants. The chemical constituents of the air pollutant mixture may affect T2DM to varying degrees. The suggested mechanisms whereby air pollutants induce T2DM include increased inflammation, oxidative stress, and endoplasmic reticulum stress.

Air Pollution During Pregnancy and Birth Outcomes in Italy

We investigate the impact of fetal exposure to air pollution on health outcomes at birth in Italy in the 2000s combining information on mother’s residential location from birth certificates with information on PM10 concentrations from air quality monitors. The potential endogeneity deriving from differential pollution exposure is addressed by exploiting as-good-as-random variation in rainfall shocks as an instrumental variable for air pollution concentrations. Our results show that both average levels of PM10 and days above the hazard limit have detrimental effects on birth weight, duration of gestation as well as overall health status at birth. These effects are mainly driven by pollution exposure during the third trimester of pregnancy and further differ in size with respect to the maternal socio-economic status, suggesting that babies born to socially disadvantaged mothers are more vulnerable. Given the non negligible effects of pollution on birth outcomes, further policy efforts are needed to fully protect fetuses from the adverse effects of air pollution and to mitigate the environmental inequality of health at birth.

Traffic-Related Air Pollution as a Risk Factor for Dementia: No Clear Modifying Effects of APOEɛ4 in the Betula Cohort.

It is widely known that the apolipoprotein E (APOE) ɛ4 allele imposes a higher risk for Alzheimer's disease (AD). Recent evidence suggests that exposure to air pollution is also a risk factor for AD, and results from a few studies indicate that the effect of air pollution on cognitive function and dementia is stronger in APOEɛ4 carriers than in non-carriers. Air pollution and interaction with APOEɛ4 on AD risk thus merits further attention. We studied dementia incidence over a 15-year period from the longitudinal Betula study in Northern Sweden. As a marker for long-term exposure to traffic-related air pollution, we used modelled annual mean nitrogen oxide levels at the residential address of the participants at start of follow-up. Nitrogen oxide correlate well with fine particulate air pollution levels in the study area. We had full data on air pollution, incidence of AD and vascular dementia (VaD), APOEɛ4 carrier status, and relevant confounding factors for 1,567 participants. As expected, air pollution was rather clearly associated with dementia incidence. However, there was no evidence for a modifying effect by APOEɛ4 on the association (p-value for interaction > 0.30 for both total dementia (AD+VaD) and AD). The results from this study do not imply that adverse effects of air pollution on dementia incidence is limited to, or stronger in, APOEɛ4 carriers than in the total population.

Growing Evidence for the Impact of Air Pollution on Depression.

The World Health Organization (WHO) estimates that 9 of every 10 people worldwide inhale polluted air, and exposure to polluted air is accountable for 7 million deaths annually.[1][1] Studies have associated the adverse effects of air pollution with respiratory, cardiovascular, and neurovascular

Air pollution exposures and blood pressure variation in type-2 diabetes mellitus patients: A retrospective cohort study in China

Air pollution exposure has been associated with hypertension, but limited studies have examined the associations in diabetic patients. We aimed to examine the associations of exposure to air pollution with blood pressure in diabetic patients. We identified patients who were previously diagnosed as type-2 diabetes mellitus from hospital records from January 2013 to May 2017. We used generalized linear models to estimate adverse effects of air pollution on systolic/diastolic blood pressure in diabetic patients. A total of 40,125 patients were enrolled in this study. An IQR increase in PM2.5, PM10, NO2, SO2, and O3 exposure was associated with an increased risk of higher systolic blood pressure level (β = 0.628 for PM2.5, β = 0.758 for PM10, β = 0.766 for NO2, β = 0.516 for SO2, β = 0.482 for O3, all P value < 0.05). Significant associations were observed for some air pollutants and SBP among patients with fasting blood glucose (FBG) ≥ 7.0 mmol/L, normal weight, and younger age. Little evidence was available for the associations between particulate matter (PM) or O3 exposure and diastolic blood pressure in present study. In our study, diabetic patients were at increased risk of higher blood pressure when exposed to higher residential PM, NO2 and SO2. Individuals with lower BMI, younger age, and FBG ≥ 7.0 mmol/L were more susceptible to the adverse effects of ambient air pollution.

Small sample robust approach to outliers and correlation of atmospheric pollution and health effects in Santiago de Chile

Adverse effects of air pollution on health are a global problem. Chile is no exception due to the increase of urban population and increasing pollution sources. For several years in the winter months in Santiago de Chile, environmental pre-emergency is decreed, which is due to the increase of measurements of contaminants and the risk that this means to health. In order to model the effects of pollution on health we consider a hierarchical Bayesian generalized linear mixed autoregressive model proposed by Ref. [18]. In particular, we apply the model to the number of children with respiratory diseases in the town of Santiago for the period June–August 2011, using the PM2.5 data as covariate obtained by a spatiotemporal pollution model. In order to detect anomalous data, we apply to residuals both robust normality tests together with novel method of probabilities for mild or extreme outliers. We detected significant heterogeneity between stations which offer us better monitoring planning for the future.AMS 2010 subject classifications. Primary 60K10; Secondary 60E15, 60E05, 62F10.

Spatial variation in the effects of air pollution on cardiovascular mortality in Beijing, China.

Due to lack of data from multiple air quality monitoring stations, studies about spatial association between concentrations of ambient pollutants and mortality in China are rare. To investigate the spatial variation of association between concentrations of particulate matter less than 10μm in aerodynamic diameter (PM10) and nitrogen dioxide (NO2) and cardiovascular mortality in Beijing, China, we collected data including daily deaths, concentrations of PM10 and NO2, and meteorological factors from January 1, 2009, to December 31, 2010, in all 16 districts of Beijing. Generalized additive model (GAM) and generalized additive mixed model (GAMM) were used to examine the citywide and district-specific effects of PM10 and NO2 on cardiovascular mortality. The citywide effect derived from GAMM was lower than that derived from GAM and the strongest effects were identified for 2-day moving average lag 0-1. For every 10μg/m3 increases in concentrations of PM10 and NO2, the corresponding daily cardiovascular mortality increases in 0.31% (95%CI 0.15%, 0.46%) and 1.63% (95%CI 1.11%, 2.13%), respectively. The death risk associated with air pollutants varied across different geographic districts in Beijing. We found spatially varied adverse effects of air pollution on cardiovascular deaths in Beijing. But there was insufficient evidence to show the significant spatial heterogeneity in mortality effects of PM10 and NO2 in this study.

Application of geostatistical approaches to predict the spatio-temporal distribution of summer ozone in Houston, Texas.

Mitigation of adverse effects of air pollution requires understanding underlying exposures, such as ambient ozone concentrations. Geostatistical approaches were employed to analyze temporal trends and estimate spatial patterns of summertime ozone concentrations for Houston, Texas, based on hourly ozone observations obtained from the Texas Commission on Environmental Quality. We systematically assess the accuracy of several spatial interpolation methods, comparing inverse distance weighting, simple kriging, ordinary kriging, and universal kriging methods utilizing the hourly ozone observations and meteorological measurements from monitoring sites. Model uncertainty was assessed by leave-one-out cross-validation. Kriging methods performed better, showing greater consistency in the generated surfaces, fewer interpolation errors, and lower biases. Universal kriging did not significantly improve the interpolation results compared to ordinary kriging, and thus ordinary kriging was determined to be the optimal method, striking a balance between accuracy and simplicity. The resulting spatial patterns indicate that the more industrialized areas east and northeast of Houston exhibit the highest summertime ozone concentrations. Estimated daily maximum 8 h ozone concentration fields generated will be used to inform research on population health risks from exposure to surface ozone in Houston.

The association between short-term ambient air pollution and daily outpatient visits for schizophrenia: A hospital-based study

Schizophrenia is a devastating neuropsychiatric disorder with increasing concern. Limited studies have been conducted to assess the relationship between short-term exposure to ambient air pollution and schizophrenia attacks. This study aimed to investigate the associations between short-term air pollution exposure and schizophrenia outpatient visits based on a time-series study performed in China. Daily data of schizophrenia outpatient admissions and air pollution from 1 October 2010 to 31 December 2013 were collected in Xi'an, a heavily-polluted city in China. We utilized a time-series Poisson regression model to examine the associations between short-term air pollution and schizophrenia outpatient visits with different lag days. A total of 34,865 outpatient-visits for schizophrenia were identified. A 10 μg/m3 increase of PM10, SO2, and NO2 concentrations corresponded to 0.289% (95% Cl: 0.118%, 0.460%), 1.374% (95% Cl: 0.723%, 2.025%), and 1.881% (95% Cl: 0.957%, 2.805%) elevation in outpatient-visits for schizophrenia at lag 0, and the associations appeared to be stronger, although not statistically significantly, in females and in middle and older age adults (40 and over). The most significant associations were observed on the concurrent day in different lag models. In conclusion, short-term exposure to ambient air pollution (PM10, SO2, and NO2) can be associated with increased risk of daily outpatient visits for schizophrenia, which may contribute to the further understanding of the potential adverse effects of air pollution in schizophrenia and other neuropsychiatric disorders.

Exposure to Air Pollutants and Variation of Blood Glucose Level among Gestational Diabetes Mellitus in China: A Retrospective Cohort Study

Background: Air pollution has been reported to be associated with risk of type 2 diabetes, but few studies were available for the associations with blood glucose level in pregnant women.Objectives: We aimed to examine the effects of exposure to air pollution on blood glucose in GDM patients in a retrospective cohort study.Methods: We identified GDM cases from hospital records among 35,722 women who were pregnant from January 2013 to May 2017.We used generalized additional models to estimate adverse effects of air pollution on fasting blood glucose and OGTT among GDM patients.Results: We identified a total of 1,347 women with GDM. An IQR increase in NO2 exposure during the second trimester was associated with an increment of fasting blood glucose (FBG) level by 0.42mmol/L. Significant associations were observed among women with younger age (&amp;#946;&amp;#61;0.55, p&amp;lt;0.05 for CO), overweight/obesity (&amp;#946;&amp;#61;0.52, p&amp;lt;0.05 for NO2, &amp;#946;&amp;#61;0.70, p&amp;lt;0.05 for CO), lower education (&amp;#946;&amp;#61;1.08, p&amp;lt;0.05 for NO2，&amp;#946;&amp;#61;0.83 for CO), and among manual labor(&amp;#946;&amp;#61;1.12, p&amp;lt;0.05 for NO2) and housewife(&amp;#946;&amp;#61;1.46, p&amp;lt;0.05 for CO). Our estimates for air pollutants (NO2 and CO) and OGTT were generally consistent with the corresponding &amp;#946; values for FBG. No evidence was observed for the association between particle matter, SO2 and Particle Matter exposure and FBG/OGTT level in our study.Conclusions: In the present study, women were at increased risk for higher blood glucose level when exposure to higher residential NO2 and CO during their pregnancy. Women with higher BMI, lower education level were more susceptible to the adverse effects of ambient air pollution.

Air Pollution Exposures and Risk of High Blood Pressure in Diabetes Mellitus Patients, China: A Retrospective Cohort Study

Background: Air pollution exposures have been associated with hypertension, but limited studies have examined the associations in diabetes mellitus patients.Objectives: We aimed to examine the associations of exposure to air pollution with risk of hypertension in diabetes mellitus patients.Methods: We identified hypertension cases from hospital records among patients who were previously diagnosed as diabetes mellitus from January 2013 to May 2017.We used generalized additional models to estimate adverse effects of air pollution on systolic/diastolic blood pressure in diabetes patients.Results: A total of 2,050 patients were enrolled in this study. A 10&amp;#956;g/m3 increase in PM2.5, PM10, SO2, and O3 exposure was associated with an increased risk of higher systolic blood pressure[D1] level (risk ratio (RR) &amp;#61;1.001; 95% confidence interval (CI):1.000, 1.002; RR &amp;#61;1.001; 95%CI: 1.000, 1.002; RR &amp;#61;1.004; 95%CI: 1.001, 1.006). Significant associations were observed with fasting blood glucose(fbg) &amp;#8805;7.0mmol/L, overweight/ obesity, and younger age. Little evidence has been observed for the associations between particulate matter (PM), SO2 and O3 exposure and diastolic blood pressure in present study.Conclusions: In our study, diabetes patients were at increased risk for higher blood pressure when exposed to higher residential PM and SO2. Individuals with higher BMI, younger age, and FBG&amp;#8805;7.0mmol/L were more susceptible to ambient air pollution.

Effects of airborne particulate matter (PM10) from dust storm and thermal inversion on global DNA methylation in human peripheral blood mononuclear cells (PBMCs) in vitro

Scientists have considered epigenetic modifications as a possible mechanism to deal with adverse effects of air pollution. This study aimed to compare the effect of PM10 (PM with aerodynamic diameter ≤ 10 μm) from dust storm and inversion conditions on in vitro global methylation in human peripheral blood mononuclear cells (PBMCs). PM10 was sampled in Tehran, Iran, at a point impacted with dust storm and inversion. PM toxicity was determined using the MTT assay. PBMCs were extracted from whole blood of healthy males and treated separately with a mixture of pooled PM10 from inversion and dusty conditions at concentrations of 50–300 μg/mL for 4 h. Untreated cells were used as the negative control. Moreover, 5-methylsytosine (%5-mC) and 5-hydroxymethylcytosine (%5-hmC) were measured by the enzyme-linked immunosorbent assay (ELISA) method. Daily average PM10 concentrations in dusty and inversion days were 348.40 and 220.54 μg/m3, respectively. The mean of %5-mC (2.04 ± 1.49%) was estimated 12 times more than that of %5-hmC (0.17 ± 0.11%). PM10 resulting from the both sources caused DNA hypomethylation; however, this effect from inversion (median = 3%, IQR = 2.4%) was found to be significantly more than that from dust storm (median = 1.1%, IQR = 1.38%). Moreover, particles increased %5-hmC caused by PM10, which was significantly greater when resulting from inversion (0.23 ± 0.1%) than from dust storm (0.12 ± 0.09%). Furthermore, %5-mC and %5-hmC were significantly different at different PM10 concentrations (50–300 μg/mL) so that a significant difference was observed between %5-mC and %5-hmC at extreme concentrations. Results showed that PM10 from inversion caused a significantly more global methylation than that from dust storm. It can be concluded that measurement of 5-mC and 5-hmC as epigenetic modifications in environmental studies of DNA methylation can be a good procedure to determine health effects related to PM10 exposure.

The application of stem cell toxicology in the health risk assessments of atmospheric pollution

In recent years, atmospheric pollution has become very common in China. Epidemiological studies have pointed out that air pollution could have significant adverse health effects, especially to children. Stem cell toxicology models are very good systems to estimate the toxicity of atmospheric pollutants, particularly during the development of early stage embryos, and the cardiovascular and nervous systems, as compared to cancer cells-based models. This review summarizes the advantages of using stem cells in the evaluation of atmospheric pollutants effects on human health, especially during development. In the near future, stem cell toxicology model should be further developed in more comprehensive evaluation systems, to in depth explain the adverse effects of air pollution on the development and function of many organs.

Is educational attainment associated with acute exposure to air pollution and pollen, and is it worse for pupils with asthma and seasonal allergic rhinitis?

IntroductionThere is a lack of evidence of the adverse effects of air pollution and pollen on cognition for people with air quality related health conditions. This study explored the effects of air quality and respiratory health conditions on educational attainment for 18,241 pupils across the city of Cardiff, United Kingdom.&#x0D; Objectives and ApproachAnonymised, routinely collected health and education data were linked at the household and school level with modelled high spatial resolution pollution data, and daily pollen measurements using the Secure Anonymised Information Linkage (SAIL) databank. This created 7 repeated cross-sectional cohorts (2009-2015). Multilevel linear regression analysis examined whether exam performance was associated with health status and/or air quality levels averaged at school and home locations during revision and examination periods. We also investigated the combined effects of air quality and associations with educational attainment for pupils who were treated for asthma and/or Severe Allergic Rhinitis (SAR), and those who were not.&#x0D; ResultsThe cohort contained 9337 males and 8904 female pupils. There were 871 treated for asthma, 2091 for SAR, and 634 treated for both. Asthma was not associated with exam performance (p=0.700). However, SAR was positively associated with exam performance (p 2) was negatively associated with educational attainment (p = 0.002). Other indicators of air quality (pollutants: Ozone, Particulate Matter - PM2.5, and pollen) were not associated with educational attainment (p&gt; 0.05). Exposure to NO2 was negatively associated with educational attainment irrespective of treatment for asthma or SAR. There was no combined effect of air quality on the variation in educational attainment between those who are treated for asthma and/or SAR and those who were not.&#x0D; Conclusion/ImplicationsIrrespective of health status, exposure to NO2 was negatively associated with educational attainment. Treatment seeking behaviour may be a possible explanation for the positive association between SAR and educational attainment. For a more accurate reflection of health status, health outcomes not subject to treatment seeking behaviour should be investigated.