Association between reported exposure to road traffic and respiratory symptoms in children: evidence of bias.
BACKGROUND
Many studies showing effects of traffic-related air pollution on health rely on self-reported exposure, which may be inaccurate. We estimated the association between self-reported exposure to road traffic and respiratory symptoms in preschool children, and investigated whether the effect could have been caused by reporting bias.


METHODS
In a random sample of 8700 preschool children in Leicestershire, UK, exposure to road traffic and respiratory symptoms were assessed by a postal questionnaire (response rate 80%). The association between traffic exposure and respiratory outcomes was assessed using unconditional logistic regression and conditional regression models (matching by postcode).


RESULTS
Prevalence odds ratios (95% confidence intervals) for self-reported road traffic exposure, comparing the categories 'moderate' and 'dense', respectively, with 'little or no' were for current wheezing: 1.26 (1.13-1.42) and 1.30 (1.09-1.55); chronic rhinitis: 1.18 (1.05-1.31) and 1.31 (1.11-1.56); night cough: 1.17 (1.04-1.32) and 1.36 (1.14-1.62); and bronchodilator use: 1.20 (1.04-1.38) and 1.18 (0.95-1.46). Matched analysis only comparing symptomatic and asymptomatic children living at the same postcode (thus exposed to similar road traffic) showed similar ORs, suggesting that parents of children with respiratory symptoms reported more road traffic than parents of asymptomatic children.


CONCLUSIONS
Our study suggests that reporting bias could explain some or even all the association between reported exposure to road traffic and disease. Over-reporting of exposure by only 10% of parents of symptomatic children would be sufficient to produce the effect sizes shown in this study. Future research should be based only on objective measurements of traffic exposure.
Kuehni
Claudia E
CE
Swiss Paediatric Respiratory Research Group, Department of Social and Preventive Medicine, University of Berne, Switzerland. kuehni@ispm.unibe.ch
Strippoli
Marie-Pierre F
MP
Zwahlen
Marcel
M
Silverman
Michael
M
D000393:Air Pollutants / Q000633:toxicity*; D001249:Asthma / Q000139:chemically induced / Q000453:epidemiology; D015982:Bias; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002675:Child, Preschool; D002908:Chronic Disease; D003371:Cough / Q000139:chemically induced / Q000453:epidemiology; D004739:England / Q000453:epidemiology; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015995:Prevalence; D012120:Respiration Disorders / Q000139:chemically induced* / Q000453:epidemiology; D012135:Respiratory Sounds; D012220:Rhinitis / Q000139:chemically induced / Q000453:epidemiology; D017678:Sex Distribution; D001335:Vehicle Emissions / Q000633:toxicity*
D000393:Air Pollutants; D001993:Bronchodilator Agents; D001335:Vehicle Emissions