title: Air pollution and respiratory infections during early childhood: an analysis of 10 European birth cohorts within the ESCAPE Project.
abstract: BACKGROUND
  Few studies have investigated traffic-related air pollution as a risk factor for respiratory infections during early childhood.
  
  
  OBJECTIVE
  We aimed to investigate the association between air pollution and pneumonia, croup, and otitis media in 10 European birth cohorts--BAMSE (Sweden), GASPII (Italy), GINIplus and LISAplus (Germany), MAAS (United Kingdom), PIAMA (the Netherlands), and four INMA cohorts (Spain)--and to derive combined effect estimates using meta-analysis.
  
  
  METHODS
  Parent report of physician-diagnosed pneumonia, otitis media, and croup during early childhood were assessed in relation to annual average pollutant levels [nitrogen dioxide (NO2), nitrogen oxide (NOx), particulate matter≤2.5 μm (PM2.5), PM2.5 absorbance, PM10, PM2.5-10 (coarse PM)], which were estimated using land use regression models and assigned to children based on their residential address at birth. Identical protocols were used to develop regression models for each study area as part of the ESCAPE project. Logistic regression was used to calculate adjusted effect estimates for each study, and random-effects meta-analysis was used to calculate combined estimates.
  
  
  RESULTS
  For pneumonia, combined adjusted odds ratios (ORs) were elevated and statistically significant for all pollutants except PM2.5 (e.g., OR=1.30; 95% CI: 1.02, 1.65 per 10-μg/m3 increase in NO2 and OR=1.76; 95% CI: 1.00, 3.09 per 10-μg/m3 PM10). For otitis media and croup, results were generally null across all analyses except for NO2 and otitis media (OR=1.09; 95% CI: 1.02, 1.16 per 10-μg/m3).
  
  
  CONCLUSIONS
  Our meta-analysis of 10 European birth cohorts within the ESCAPE project found consistent evidence for an association between air pollution and pneumonia in early childhood, and some evidence for an association with otitis media.
authors.affiliation: Institute of Epidemiology I, Helmholtz Zentrum München, German Research Centre for Environmental Health, Munich, Germany.
authors.forename: Elaina A
authors.initials: EA
authors.lastname: MacIntyre
authors.forename: Ulrike
authors.initials: U
authors.lastname: Gehring
authors.forename: Anna
authors.initials: A
authors.lastname: Mölter
authors.forename: Elaine
authors.initials: E
authors.lastname: Fuertes
authors.forename: Claudia
authors.initials: C
authors.lastname: Klümper
authors.forename: Ursula
authors.initials: U
authors.lastname: Krämer
authors.forename: Ulrich
authors.initials: U
authors.lastname: Quass
authors.forename: Barbara
authors.initials: B
authors.lastname: Hoffmann
authors.forename: Mireia
authors.initials: M
authors.lastname: Gascon
authors.forename: Bert
authors.initials: B
authors.lastname: Brunekreef
authors.forename: Gerard H
authors.initials: GH
authors.lastname: Koppelman
authors.forename: Rob
authors.initials: R
authors.lastname: Beelen
authors.forename: Gerard
authors.initials: G
authors.lastname: Hoek
authors.forename: Matthias
authors.initials: M
authors.lastname: Birk
authors.forename: Johan C
authors.initials: JC
authors.lastname: de Jongste
authors.forename: H A
authors.initials: HA
authors.lastname: Smit
authors.forename: Josef
authors.initials: J
authors.lastname: Cyrys
authors.forename: Olena
authors.initials: O
authors.lastname: Gruzieva
authors.forename: Michal
authors.initials: M
authors.lastname: Korek
authors.forename: Anna
authors.initials: A
authors.lastname: Bergström
authors.forename: Raymond M
authors.initials: RM
authors.lastname: Agius
authors.forename: Frank
authors.initials: F
authors.lastname: de Vocht
authors.forename: Angela
authors.initials: A
authors.lastname: Simpson
authors.forename: Daniela
authors.initials: D
authors.lastname: Porta
authors.forename: Francesco
authors.initials: F
authors.lastname: Forastiere
authors.forename: Chiara
authors.initials: C
authors.lastname: Badaloni
authors.forename: Giulia
authors.initials: G
authors.lastname: Cesaroni
authors.forename: Ana
authors.initials: A
authors.lastname: Esplugues
authors.forename: Ana
authors.initials: A
authors.lastname: Fernández-Somoano
authors.forename: Aitana
authors.initials: A
authors.lastname: Lerxundi
authors.forename: Jordi
authors.initials: J
authors.lastname: Sunyer
authors.forename: Marta
authors.initials: M
authors.lastname: Cirach
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Nieuwenhuijsen
authors.forename: Göran
authors.initials: G
authors.lastname: Pershagen
authors.forename: Joachim
authors.initials: J
authors.lastname: Heinrich
mesh_terms: D000393:Air Pollutants / Q000633:toxicity; D000397:Air Pollution / Q000009:adverse effects*; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D010033:Otitis Media / Q000139:chemically induced / Q000453:epidemiology; D052638:Particulate Matter / Q000633:toxicity; D011014:Pneumonia / Q000139:chemically induced / Q000453:epidemiology; D012141:Respiratory Tract Infections / Q000139:chemically induced* / Q000453:epidemiology*
chemical_list: D000393:Air Pollutants; D052638:Particulate Matter