Air pollution exposure and lung function in children: the ESCAPE project

Abstract

Background: There is evidence for adverse effects of outdoor air pollution on lung function of children. Quantitative summaries of the effects of air pollution on lung function, however, are lacking due to large differences among studies.

Objectives: We aimed to study the association between residential exposure to air pollution and lung function in five European birth cohorts with a standardized exposure assessment following a common protocol.

Methods: As part of the European Study of Cohorts for Air Pollution Effects (ESCAPE) we analyzed data from birth cohort studies situated in Germany, Sweden, the Netherlands, and the United Kingdom that measured lung function at 6-8 years of age (n = 5,921). Annual average exposure to air pollution [nitrogen oxides (NO2, NOx), mass concentrations of particulate matter with diameters < 2.5, < 10, and 2.5-10 μm (PM2.5, PM10, and PMcoarse), and PM2.5 absorbance] at the birth address and current address was estimated by land-use regression models. Associations of lung function with estimated air pollution levels and traffic indicators were estimated for each cohort using linear regression analysis, and then combined by random effects meta-analysis.

Results: Estimated levels of NO2, NOx, PM2.5 absorbance, and PM2.5 at the current address, but not at the birth address, were associated with small decreases in lung function. For example, changes in forced expiratory volume in 1 sec (FEV1) ranged from -0.86% (95% CI: -1.48, -0.24%) for a 20-μg/m3 increase in NOx to -1.77% (95% CI: -3.34, -0.18%) for a 5-μg/m3 increase in PM2.5.

Conclusions: Exposure to air pollution may result in reduced lung function in schoolchildren.

Figure 1

Adjusted center-specific and combined (meta-random) associations of annual average levels of air pollution and traffic indicators with FEV₁. Error bars are 95% CIs. Associations with exposures at birth address are represented by black dots, and associations with exposures at current address by white dots. Estimates are adjusted for age, sex, height, weight, recent respiratory infections, ethnicity/nationality, parental education, allergic mother, allergic father, breastfeeding, mother smoking during pregnancy, smoking at home, mold/dampness at home, furry pets at home. Associations are presented for the following increments in exposure: 10 μg/m³ for NO₂, 20 μg/m³ for NO_x, 1 unit for PM_2.5 absorbance (PM_2.5abs), 5 μg/m³ for PM_2.5, 10 μg/m³ for PM₁₀, 5 μg/m³ for PM_coarse, 5,000 vehicles/day for traffic intensity on the nearest street; and 4,000 vehicle-km/day for traffic load on major roads within a 100-m buffer; associations with traffic intensity and traffic load were additionally adjusted for background NO₂ concentrations.