Influence of socioeconomic deprivation on the relation between air pollution and beta-agonist sales for asthma.
BACKGROUND
Air pollution triggers asthma attacks hours to days after exposure. It remains unclear whether socioeconomic deprivation modulates these effects. Investigation of these interactions requires adequate statistical power, obtainable by using either a sufficient number of observations or very sensitive indicators of asthma attacks. Using a small-area temporal ecologic approach, we studied the short-term relations between ambient air pollution and sales of short-acting beta-agonist (SABA) drugs, a frequent and specific treatment for control of asthma attacks in children and young adults, and then tested the influence of deprivation on these relations.


METHODS
The study took place in Strasbourg, France in 2004. Health insurance funds provided data on 15,121 SABA sales for patients aged 0 to 39 years. Deprivation was estimated by small geographic areas using an index constructed from census data. Daily average ambient concentrations of particulate matter (particles with an aerodynamic diameter < 10 microm [PM(10)]), nitrogen dioxide (NO(2)), and ozone (O(3)) were modeled on a small-area level. Adjusted case-crossover models were used for statistical analysis.


RESULTS
Increased of 10 microg/m(3) in ambient PM(10), NO(2), and O(3) concentrations were associated, respectively, with increases of 7.5% (95% confidence interval [CI], 4 to 11.2%), 8.4% (95% CI, 5 to 11.9%), and 1% (95% CI, - 0.3 to 2.2%) in SABA sales. Deprivation had no influence on these relations.


CONCLUSIONS
The associations observed are consistent with those reported by studies focusing on SABA use. Similar studies in other settings should confirm whether the lack of interaction with deprivation is due to specific local conditions.
Laurent
Olivier
O
LERES, Ecole des Hautes Etudes en Santé Publique, Rennes.
Pedrono
Gaëlle
G
SEPIA Santé, Baud.
Filleul
Laurent
L
CIRE Aquitaine, Institut de Veille Sanitaire, Bordeaux.
Segala
Claire
C
SEPIA Santé, Baud.
Lefranc
Agnès
A
Département Santé Environnement, Institut de Veille Sanitaire, Saint Maurice.
Schillinger
Charles
C
Association pour la Surveillance et l'Etude de la Pollution Atmosphérique en Alsace, Schiltigheim.
Rivière
Emmanuel
E
Association pour la Surveillance et l'Etude de la Pollution Atmosphérique en Alsace, Schiltigheim.
Bard
Denis
D
LERES, Ecole des Hautes Etudes en Santé Publique, Rennes. Electronic address: denis.bard@ehesp.fr.
D000293:Adolescent; D000318:Adrenergic beta-Agonists / Q000191:economics / Q000627:therapeutic use*; D000328:Adult; D000397:Air Pollution / Q000009:adverse effects* / Q000032:analysis; D001249:Asthma / Q000188:drug therapy / Q000191:economics / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D004363:Drug Utilization; D005602:France; D006801:Humans; D007223:Infant; D009585:Nitrogen Dioxide / Q000009:adverse effects / Q000032:analysis; D010126:Ozone / Q000009:adverse effects / Q000032:analysis; D010594:Pharmacies / Q000191:economics; D011203:Poverty; D012307:Risk Factors; D012923:Social Class; D014504:Urban Health; D055815:Young Adult
D000318:Adrenergic beta-Agonists; D010126:Ozone; D009585:Nitrogen Dioxide