Abstract：
BACKGROUND: Constrained by no proper way to assess cumulative exposure, the joint effect of air pollution cumulative exposure doses on childhood asthma and wheezing (AW) was not understood.
OBJECTIVE: To assess the association between cumulative exposure to multiple air pollutants in early life and childhood AW.
METHODS: We designed a nested case-control study based on the birth cohort in Jinan City. Children with AW followed up within 2 years after birth were treated as cases, and non-cases in this cohort were treated as the control source population, and the propensity score matching method was used to match each case to 5 controls. We calculated the individual cumulative outdoor exposure doses for each period using an inverse distance weighted model, alongside the complex Simpson\'s formula, accounting for outdoor time and respiratory volume. The Least absolute shrinkage and selection operator (Lasso) regression was performed to screen for covariates. To analyze the joint effects of pollutants, we employed the weighted quantile sum (WQS) regression model in conjunction with conditional logistic regression.
RESULTS: 84 cases and 420 controls were included in this study. The odds ratio (OR) with 95% confidence interval (CI) of the impact of cumulative exposure (mg/m3) after birth on childhood AW was 1.78 (1.15-2.74) for SO2, 1.69 (1.11-2.57) for NO2, and 1.65 (1.09-2.52) for PM2.5, respectively. Furthermore, with each 25th percentile increase in the WQS index, the overall risk of cumulative doses for six pollutants exposure after birth on AW increased by an adjusted OR of 1.10 (1.03, 1.18), and SO2, PM2.5, and NO2 contributed the most to the WQS index. However, no statistically significant association was found between cumulative exposure to all pollutants before birth and childhood AW.
CONCLUSIONS: There was a joint effect of the cumulative exposure dose of outdoor air pollutants after birth on AW in children aged 0-2 years. And traffic-related pollutants (SO2, PM2.5, and NO2) make a greater contribution to the joint effect.
OBJECTIVE: To assess the association between cumulative exposure to multiple air pollutants in early life and childhood AW.
METHODS: We designed a nested case-control study based on the birth cohort in Jinan City. Children with AW followed up within 2 years after birth were treated as cases, and non-cases in this cohort were treated as the control source population, and the propensity score matching method was used to match each case to 5 controls. We calculated the individual cumulative outdoor exposure doses for each period using an inverse distance weighted model, alongside the complex Simpson\'s formula, accounting for outdoor time and respiratory volume. The Least absolute shrinkage and selection operator (Lasso) regression was performed to screen for covariates. To analyze the joint effects of pollutants, we employed the weighted quantile sum (WQS) regression model in conjunction with conditional logistic regression.
RESULTS: 84 cases and 420 controls were included in this study. The odds ratio (OR) with 95% confidence interval (CI) of the impact of cumulative exposure (mg/m3) after birth on childhood AW was 1.78 (1.15-2.74) for SO2, 1.69 (1.11-2.57) for NO2, and 1.65 (1.09-2.52) for PM2.5, respectively. Furthermore, with each 25th percentile increase in the WQS index, the overall risk of cumulative doses for six pollutants exposure after birth on AW increased by an adjusted OR of 1.10 (1.03, 1.18), and SO2, PM2.5, and NO2 contributed the most to the WQS index. However, no statistically significant association was found between cumulative exposure to all pollutants before birth and childhood AW.
CONCLUSIONS: There was a joint effect of the cumulative exposure dose of outdoor air pollutants after birth on AW in children aged 0-2 years. And traffic-related pollutants (SO2, PM2.5, and NO2) make a greater contribution to the joint effect.
摘要：
背景：由于没有适当的方法来评估累积暴露，空气污染累积暴露剂量对儿童哮喘和喘息(AW)的联合影响尚不清楚.
目的：评估早年累积暴露于多种空气污染物与儿童AW之间的关系。
方法：我们设计了一项基于济南市出生队列的巢式病例对照研究。将出生后2年内随访的AW儿童作为病例处理，该队列中的非病例被视为对照来源人群，并采用倾向评分匹配方法将每个病例与5个对照进行匹配。我们使用反距离加权模型计算了每个时期的个人累积户外暴露剂量，除了复杂的辛普森公式，考虑室外时间和呼吸量。进行最小绝对收缩和选择算子(Lasso)回归以筛选协变量。为了分析污染物的共同影响，我们将加权分位数和(WQS)回归模型与条件逻辑回归相结合。
结果：本研究包括84例和420例对照。出生后累积暴露（mg/m3）对儿童AW的影响的比值比（OR）与95％置信区间（CI）分别为SO2的1.78（1.15-2.74），NO2的1.69（1.11-2.57）和PM2.5的1.65（1.09-2.52）。此外，随着WQS指数每增加25个百分位数，出生后AW上六种污染物暴露的累积剂量的总体风险增加了1.10（1.03，1.18），SO2、PM2.5和NO2对WQS指数的贡献最大。然而,出生前累积暴露于所有污染物与儿童AW之间没有统计学显著关联.
结论：出生后室外空气污染物的累积暴露剂量对0-2岁儿童的AW有共同影响。与交通相关的污染物（SO2，PM2.5和NO2）对联合效应的贡献更大。
目的：评估早年累积暴露于多种空气污染物与儿童AW之间的关系。
方法：我们设计了一项基于济南市出生队列的巢式病例对照研究。将出生后2年内随访的AW儿童作为病例处理，该队列中的非病例被视为对照来源人群，并采用倾向评分匹配方法将每个病例与5个对照进行匹配。我们使用反距离加权模型计算了每个时期的个人累积户外暴露剂量，除了复杂的辛普森公式，考虑室外时间和呼吸量。进行最小绝对收缩和选择算子(Lasso)回归以筛选协变量。为了分析污染物的共同影响，我们将加权分位数和(WQS)回归模型与条件逻辑回归相结合。
结果：本研究包括84例和420例对照。出生后累积暴露（mg/m3）对儿童AW的影响的比值比（OR）与95％置信区间（CI）分别为SO2的1.78（1.15-2.74），NO2的1.69（1.11-2.57）和PM2.5的1.65（1.09-2.52）。此外，随着WQS指数每增加25个百分位数，出生后AW上六种污染物暴露的累积剂量的总体风险增加了1.10（1.03，1.18），SO2、PM2.5和NO2对WQS指数的贡献最大。然而,出生前累积暴露于所有污染物与儿童AW之间没有统计学显著关联.
结论：出生后室外空气污染物的累积暴露剂量对0-2岁儿童的AW有共同影响。与交通相关的污染物（SO2，PM2.5和NO2）对联合效应的贡献更大。
