title: The impact of climate and traffic-related NO2 on the prevalence of asthma and allergic rhinitis in Italy.
abstract: BACKGROUND
  Environmental factors are likely to be involved in explaining the wide geographical variation in asthma and atopic diseases that has been documented in many recent epidemiological studies.
  
  
  OBJECTIVE
  To evaluate to what extent climate and outdoor NO2 pollution can explain the geographical variation in the prevalence of asthma and allergic rhinitis, and to estimate the relative risk for exposure to different levels of these two factors.
  
  
  METHODS
  The impact of climate and long-term exposure to nitrogen dioxide (NO2) pollution on asthma and allergic rhinitis was assessed in a cross-sectional study, carried out during 1998 to 2000 on young adults aged 20 to 44 years (n = 18 873), living in 13 areas from two different Italian climatic regions (subcontinental and Mediterranean).
  
  
  RESULTS
  Mediterranean areas had a significantly higher prevalence of asthma-like symptoms (P < 0.001), higher annual mean temperature (16.2 degrees C vs. 12.9 degrees C), lower temperature range (16.0 C degrees vs. 22.1 degrees C) and lower NO2 levels (31.46 microg/m3 vs. 57.99 microg/m3) than subcontinental ones. Mediterranean climate was associated with an increased risk of wheeze (OR = 1.23; 95% CI 1.13 to 1.35), tightness in the chest (OR = 1.21; 95% CI 1.11 to 1.33), shortness of breath (OR = 1.21; 95% CI 1.08 to 1.36) and asthma attacks (OR = 1.19; 95% CI 1.07 to 1.31). After adjusting for climate, an increase of 18.3 microg/m3 in NO2 levels moderately increased the risk of asthma attacks (OR = 1.13; 95% CI 0.98 to 1.32), tightness in the chest (OR = 1.11; 95% CI 0.98 to 1.26) and wheeze (OR = 1.11; 95% CI 0.96 to 1.28). When the levels of outdoor NO2 exposure rose, the prevalence of allergic rhinitis increased significantly in the Mediterranean region (OR = 1.38; 95% CI 1.12 to 1.69), but not in the subcontinental one (OR = 1.03; 95% CI 0.83 to 1.28).
  
  
  CONCLUSIONS
  Our results show that the prevalence of asthma increases when annual mean temperature increases and temperature range decreases. Furthermore, climate interacts with NO2 outdoor exposure, increasing the risk for allergic rhinitis in people exposed to high stable temperatures. A long-term role for the effect of traffic pollution on asthma is also suggested.
authors.affiliation: Unit of Epidemiology and Medical Statistics, Department of Medicine and Public Health, University of Verona, Verona, Italy. demarco@biometria.univr.it
authors.forename: R
authors.initials: R
authors.lastname: de Marco
authors.forename: A
authors.initials: A
authors.lastname: Poli
authors.forename: M
authors.initials: M
authors.lastname: Ferrari
authors.forename: S
authors.initials: S
authors.lastname: Accordini
authors.forename: G
authors.initials: G
authors.lastname: Giammanco
authors.forename: M
authors.initials: M
authors.lastname: Bugiani
authors.forename: S
authors.initials: S
authors.lastname: Villani
authors.forename: M
authors.initials: M
authors.lastname: Ponzio
authors.forename: R
authors.initials: R
authors.lastname: Bono
authors.forename: L
authors.initials: L
authors.lastname: Carrozzi
authors.forename: R
authors.initials: R
authors.lastname: Cavallini
authors.forename: L
authors.initials: L
authors.lastname: Cazzoletti
authors.forename: R
authors.initials: R
authors.lastname: Dallari
authors.forename: F
authors.initials: F
authors.lastname: Ginesu
authors.forename: P
authors.initials: P
authors.lastname: Lauriola
authors.forename: P
authors.initials: P
authors.lastname: Mandrioli
authors.forename: L
authors.initials: L
authors.lastname: Perfetti
authors.forename: S
authors.initials: S
authors.lastname: Pignato
authors.forename: P
authors.initials: P
authors.lastname: Pirina
authors.forename: P
authors.initials: P
authors.lastname: Struzzo
mesh_terms: D000328:Adult; D001249:Asthma / Q000453:epidemiology* / Q000209:etiology; D002980:Climate; D003430:Cross-Sectional Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D015999:Multivariate Analysis; D009585:Nitrogen Dioxide / Q000009:adverse effects*; D015995:Prevalence; D012221:Rhinitis, Allergic, Perennial / Q000453:epidemiology* / Q000209:etiology; D013696:Temperature; D014466:Ultraviolet Rays; D001335:Vehicle Emissions
chemical_list: D001335:Vehicle Emissions; D009585:Nitrogen Dioxide