ISEE-444 Abstract: We undertook a cohort study to evaluate the relationship between ambient air pollution and early childhood respiratory morbidity in an eastern European country during the years 1994-1999. We examined the associations between winter (November through March) measures of fine- and coarse-fraction particulate matter (PM2.5 and PM10-2.5), sulfur dioxide (SO2), nitrogen oxides (NOX), and polycyclic aromatic hydrocarbons (PAHs) and the incidence of lower respiratory illnesses (LRI) in children from birth to three years of age. Study sites were located in two districts, one with high outdoor air pollution from power plants and coal home heating emissions, and the other an area with lower average outdoor air pollution. Morbidity and questionnaire information at three years was available for 452 children. All sick- and well-child visit diagnoses during the first three years of life were abstracted from pediatric records using ICD-10 classifications and categorized into broad illness groupings. Analyses reported here made use of an LRI grouping that included bronchitis and bronchiolitis (979 diagnoses) but excluded pneumonia (70 diagnoses). Multivariable analyses applied generalized estimating equation methods and adjusted for temperature, day of the week, district of residence, and year. In single-pollutant models, we found that LRI incidence increased with increasing concentrations of PM2.5, PM10-2.5, PAHs and NOX, but not with SO2. Though effect estimates were imprecise, an overall pattern emerged, with LRI incidence increasing with elevated air pollutant levels on the same day and the one or two days preceding diagnosis. For an interquartile range (IQR) increase in pollutant concentration, LRI incidence increased 12% (95% CI: −2.4%, 28%) for same-day PM2.5, 3.5% (95% CI: −1.6%, 8.9%) for same-day PM10-2.5, 8.1% (95% CI: −4.6%, 22%) for previous-day total PAHs, and 8.5% (95% CI: −6.1%, 25%) for three-day average NOX. Among children whose homes were heated primarily with coal, we observed much stronger pollutant-LRI associations. Per IQR-increase in three-day average pollutant levels, LRI incidence increased 84% (95% CI: 22%, 176%) for PM2.5, 24% (95% CI: 5.9%, 45%) for PM10-2.5, 33% (95% CI: 9.7%, 62%) for PAHs, and 22% (95% CI: −14%, 73%) for NOX. These findings underscore the importance of considering indoor and microenvironmental exposures in air pollution health studies conducted in a setting similar to this eastern European location, where local household emissions significantly impact outdoor pollutant concentrations.
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