title: Interactions Between Air Pollution and Obesity on Blood Pressure and Hypertension in Chinese Children.
abstract: BACKGROUND
  Little information exists regarding the effect of interaction of obesity and long-term air pollution exposure on children's blood pressure and hypertension in areas with high levels of air pollution. The aim of this study is to assess effect modification by obesity on the association between exposure and blood pressure in Chinese children.
  
  
  METHODS
  We studied 9,354 Chinese children, ages 5-17 years old, from 24 elementary schools and 24 middle schools in the Seven Northeastern Cities during 2012-2013. Four-year average concentrations of particles with an aerodynamic diameter ≤10 µm (PM10), sulfur dioxide, nitrogen dioxides, and ozone (O3) were measured at the monitoring stations in the 24 districts. We used generalized additive models and two-level logistic regression models to examine the health effects.
  
  
  RESULTS
  Consistent interactions were found between exposure and obesity on blood pressure and hypertension. The association between exposure and hypertension was consistently larger for overweight/obese children than for children with normal-weight, with odds ratios for hypertension ranging from 1.16 per 46.3μg/m for O3 (95% confidence interval [CI] = 1.12, 1.20) to 2.91 per 30.6μg/m for PM10 (95% CI = 2.32, 3.64), and estimated increases in mean systolic and diastolic blood pressure ranging from 0.57 mmHg (95% CI = 0.36, 0.78) and 0.63 mmHg (95% CI = 0.46, 0.81) per 46.3 μg/m for O3 to 4.04 mmHg (95% CI = 3.00, 5.09) and 2.02 mmHg (95% CI = 1.14, 2.89) per 23.4 μg/m for sulfur dioxide.
  
  
  CONCLUSIONS
  Obesity amplifies the association of long-term air pollution exposure with blood pressure and hypertension in Chinese children.
authors.affiliation: From the aGuangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, bDepartment of Environmental and Occupational Health, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong Province, People's Republic of China; cDepartment of Biostatistics, College for Public Health and Social Justice, St Louis University, St Louis, MO; dDepartment of Mathematics and Statistics, James Madison University, Harrisonburg, VA; eDepartment of Biostatistics and Epidemiology, Graduate School of Public Health, San Diego State University, San Diego, CA; fDepartment of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning Province, People's Republic of China; and gDepartment of Ambient Air Pollution Monitor, Shenyang Environmental Monitoring Center, Shenyang, Liaoning Province, People's Republic of China.
authors.forename: Guang-Hui
authors.initials: GH
authors.lastname: Dong
authors.forename: Jing
authors.initials: J
authors.lastname: Wang
authors.forename: Xiao-Wen
authors.initials: XW
authors.lastname: Zeng
authors.forename: Lihua
authors.initials: L
authors.lastname: Chen
authors.forename: Xiao-Di
authors.initials: XD
authors.lastname: Qin
authors.forename: Yang
authors.initials: Y
authors.lastname: Zhou
authors.forename: Meng
authors.initials: M
authors.lastname: Li
authors.forename: Mingan
authors.initials: M
authors.lastname: Yang
authors.forename: Yang
authors.initials: Y
authors.lastname: Zhao
authors.forename: Wan-Hui
authors.initials: WH
authors.lastname: Ren
authors.forename: Qian-Sheng
authors.initials: QS
authors.lastname: Hu
mesh_terms: D000293:Adolescent; D000393:Air Pollutants / Q000009:adverse effects* / Q000032:analysis; D000397:Air Pollution / Q000009:adverse effects* / Q000032:analysis / Q000706:statistics & numerical data; D001794:Blood Pressure; D002648:Child; D002675:Child, Preschool; D002681:China; D003430:Cross-Sectional Studies; D015987:Effect Modifier, Epidemiologic; D004781:Environmental Exposure / Q000009:adverse effects* / Q000032:analysis / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology*; D016015:Logistic Models; D008297:Male; D052638:Particulate Matter / Q000009:adverse effects* / Q000032:analysis; D063766:Pediatric Obesity / Q000150:complications*; D014504:Urban Health
chemical_list: D000393:Air Pollutants; D052638:Particulate Matter