title: Industrial air pollution and children's respiratory health: a natural experiment in Călăraşi.
abstract: BACKGROUND
  In 1993-1997, we described a high incidence of wheezing in children living near the iron, steel, and coke factory of Călăraşi (Romania). In 1998, the factory was closed.
  
  
  OBJECTIVE
  To investigate the influence of closing the factory on the incidence of wheezing in children living near the factory.
  
  
  METHODS
  We used this natural experiment to compare wheezing occurrence in children below age 2 in an area near the factory and in a village 10 km from the factory (Roseţi). We studied three birth cohorts: those 2 years old before the closing of the factory (group 1), those born before the closing and returning 2 after the closing (group 2), those born after the closing (group 3).
  
  
  RESULTS
  The relative risk (95% CI) of having at least one episode of wheezing during the first life-year was 0.51 (0.30-0.85) in group 3 versus group 1, and 0.95 (0.64-1.40) for group 2 versus group 1. After adjusting for possible confounders, the incidence dropped in Călăraşi (odds ratio [OR] 0.38, 95% CI 0.19-0.76), while it increased in Roseţi (OR 8.36, 95% CI 1.84-38.0). Results for the 2-year incidence were similar.
  
  
  CONCLUSIONS
  Industrial air pollution by the factory was the main risk factor for wheezing during the first life-years of the children of Călăraşi. Closing the factory resulted in a significant decrease in wheezing incidence rates, which still remained higher than in a nearby village.
authors.affiliation: Department of General Practice, University of Maastricht, Maastricht, The Netherlands. carmen_cara@zappmobile.ro
authors.forename: Alexandra Carmen
authors.initials: AC
authors.lastname: Câra
authors.forename: Frank
authors.initials: F
authors.lastname: Buntinx
authors.forename: Marjan
authors.initials: M
authors.lastname: Van den Akker
authors.forename: Geert-Jan
authors.initials: GJ
authors.lastname: Dinant
authors.forename: Carmen
authors.initials: C
authors.lastname: Manolovici
mesh_terms: D000393:Air Pollutants / Q000633:toxicity*; D000397:Air Pollution / Q000009:adverse effects*; D015331:Cohort Studies; D003077:Coke; D004781:Environmental Exposure / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007221:Industry; D007223:Infant; D007501:Iron; D016017:Odds Ratio; D011446:Prospective Studies; D012135:Respiratory Sounds / Q000209:etiology*; D012306:Risk; D018570:Risk Assessment; D012383:Romania; D013232:Steel; D013997:Time Factors
chemical_list: D000393:Air Pollutants; D003077:Coke; D013232:Steel; D007501:Iron