title: Kawasaki Disease and Exposure to Fine Particulate Air Pollution.
abstract: To analyze associations of short-term exposure to fine particulate matter (diameter ≤ 2.5 µm [PM2.5]), a measurable component of urban pollution, with the event date of fever onset for patients with Kawasaki disease (KD) residing in 7 metropolitan regions.
  
  
  
  A case-crossover study design was used. Time trends, seasonality, month, and weekday were controlled for by matching. We assembled PM2.5 exposure measurements from urban monitors and imputed PM2.5 to provide day-to-day temporal variability and resolution for time series indexes of exposures. Selected exposure windows (to 14 days) of PM2.5 were examined.
  
  
  
  A total of 3009 KD events were included for which the subject resided within a study metropolitan area and the event date occurred during years with available PM2.5. The estimated ORs (with 95% CIs) of an event of KD associated with a 10 µg/m(3) PM2.5 lagged moving average concentration of lagged exposure period (ie, concurrent, preceding day[s]) revealed no evidence of a consistent, statistically significant, positive association between elevated PM2.5 exposure and increased risk of KD. Extended analysis with stratification by city, sex, age, ethnic origin, incomplete or complete clinical manifestations, the presence of coronary aneurysm, and intravenous immunoglobulin resistance did not provide evidence of a consistent, statistically significant, positive association between elevated exposure to PM2.5 and increased risk of KD for any of the strata studied.
  
  
  
  This multicity study failed to establish a risk of the event of KD with short-term fine particulate exposure. Our negative findings add to the growing field of environmental epidemiology research of KD.
authors: Department of Pediatrics, Rheumatology, The Cleveland Clinic, Cleveland, OH. Electronic address: zefta@ccf.org.
authors: Andrew S
authors: AS
authors: Zeft
authors: Department of Pediatrics, Infectious Disease, University California San Diego, San Diego, CA.
authors: Jane C
authors: JC
authors: Burns
authors: Department of Pediatrics, Rheumatology, Cardiology, University of Toronto, Toronto, ON.
authors: Rae S
authors: RS
authors: Yeung
authors: Department of Pediatrics, Rheumatology, Cardiology, University of Toronto, Toronto, ON.
authors: Brian W
authors: BW
authors: McCrindle
authors: Department of Pediatrics, Cardiology, Harvard University, Boston, MA.
authors: Jane W
authors: JW
authors: Newburger
authors: Department of Pediatrics, Infectious Disease, University of Colorado, Denver, CO.
authors: Samuel R
authors: SR
authors: Dominguez
authors: Department of Pediatrics, Infectious Disease, University of Colorado, Denver, CO.
authors: Marsha S
authors: MS
authors: Anderson
authors: Department of Pediatrics, Cardiology, University of Utah, Salt Lake City, UT.
authors: Cammon
authors: C
authors: Arrington
authors: Department of Pediatrics, Infectious Disease, Northwestern University, Chicago, IL.
authors: Stanford T
authors: ST
authors: Shulman
authors: Department of Pediatrics, Cleveland Clinic, Cleveland, OH.
authors: Jeein
authors: J
authors: Yoon
authors: Department of Pediatrics, Cleveland Clinic, Cleveland, OH.
authors: Helen
authors: H
authors: Tewelde
authors: Department of Economics, Brigham Young University, Provo, UT.
authors: Carter
authors: C
authors: Mix
authors: Department of Economics, Brigham Young University, Provo, UT.
authors: C Arden
authors: CA
authors: Pope
mesh_terms: D002170:Canada; D002648:Child; D002675:Child, Preschool; D018592:Cross-Over Studies; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000209:etiology*; D010316:Particle Size; D052638:Particulate Matter / Q000009:adverse effects*; D013997:Time Factors; D014481:United States; D014504:Urban Health
chemical_list: D052638:Particulate Matter
keywords: Kawasaki disease; air pollution; environmental epidemiology