title: The population attributable fraction of asthma among Canadian children.
abstract: OBJECTIVE
  We calculated the population attributable fraction (PAF) of Canadian childhood asthma due to modifiable environmental exposures, in order to estimate their relative contributions to asthma development based on the current literature.
  
  
  METHODS
  We conducted a systematic review to determine Canadian childhood asthma incidence, Canadian prevalence of exposure to airborne pollutants and indoor allergens, and international estimates of the risk of developing physician-diagnosed asthma (PDA) associated with each exposure. Combining risk estimates by meta-analysis where possible, PAF was calculated by the formula: PAF = Attributable risk *Exposure prevalence* 100%/Asthma incidence.
  
  
  RESULTS
  Age-specific Canadian childhood asthma incidence ranged from 2.8%-6.9%. Canadian exposure prevalences were: PM10 16%, PM2.5 7.1%, NO2 25%, environmental tobacco smoke (ETS) 9.0%, cat 22%, dog 12%, mouse 17%, cockroach 9.8%, dust mite 30%, moisture 14% and mould 33%. Relative risk estimates of PDA were: PM10 1.64, PM2.5 1.44, NO2 1.29, ETS 1.40, mouse 1.23, cockroach 1.96, and spanned 1.00 for cat, dog, dust mites, moisture and mould. PAF estimates for incident asthma among preschool children were: PM10 11%, PM2.5 1.6%, NO2 4.0%, ETS 2.9%, mouse 6.5% and cockroach 13%.
  
  
  CONCLUSIONS
  This systematic review suggests contributions to childhood asthma development from exposure to particulates, NO2, ETS, mouse and cockroach. The associations appeared to be more complex for cat, dog and dust mite allergens and more variable for mould and moisture. Additional prospective, population-based studies of childhood asthma development with objectively-measured exposures are needed to further quantify these associations.
authors.affiliation: Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON. elinor.simons@sickkids.ca
authors.forename: Elinor
authors.initials: E
authors.lastname: Simons
authors.forename: Teresa
authors.initials: T
authors.lastname: To
authors.forename: Sharon
authors.initials: S
authors.lastname: Dell
mesh_terms: D000293:Adolescent; D000393:Air Pollutants / Q000009:adverse effects*; D000485:Allergens / Q000009:adverse effects*; D001249:Asthma / Q000453:epidemiology / Q000209:etiology*; D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004781:Environmental Exposure / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015995:Prevalence; D012306:Risk; D055815:Young Adult
chemical_list: D000393:Air Pollutants; D000485:Allergens