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. 2014 Jun;164(6):1396-1402.e1.
doi: 10.1016/j.jpeds.2014.02.017. Epub 2014 Mar 27.

Traffic-related air pollution and asthma hospital readmission in children: a longitudinal cohort study

Nicholas C Newman  1 , Patrick H Ryan  2 , Bin Huang  2 , Andrew F Beck  3 , Hadley S Sauers  3 , Robert S Kahn  4
Affiliations

Traffic-related air pollution and asthma hospital readmission in children: a longitudinal cohort study

Nicholas C Newman et al. J Pediatr. 2014 Jun.

Abstract

Objective: To examine the association between exposure to traffic-related air pollution (TRAP) and hospital readmission for asthma or bronchodilator-responsive wheezing.

Study design: A population-based cohort of 758 children aged 1-16 years admitted for asthma or bronchodilator-responsive wheezing was assessed for asthma readmission within 12 months. TRAP exposure was estimated with a land use regression model using the home address at index admission, with TRAP dichotomized at the sample median (0.37 μg/m3). Covariates included allergen-specific IgE, tobacco smoke exposure, and social factors obtained at enrollment. Associations between TRAP exposure and readmission were assessed using logistic regression and Cox proportional hazards models.

Results: The study cohort was 58% African American and 32% white; 19% of the patients were readmitted within 12 months of the original admission. Higher TRAP exposure was associated with a higher readmission rate (21% vs. 16%; P = .05); this association was not significant after adjusting for covariates (aOR, 1.4; 95% CI, 0.9-2.2). Race modified the observed association; white children with high TRAP exposure had 3-fold higher odds of asthma readmission (OR, 3.0; 95% CI, 1.1-8.1), compared with white children with low TRAP exposure. In African American children, TRAP exposure was not associated with increased readmission (OR, 1.1; 95% CI, 0.6-1.8). In children with high TRAP exposure, TRAP exposure was associated with decreased time to readmission in white children (hazard ratio, 3.2; 95% CI, 1.5-6.7) compared with African American children (hazard ratio, 1.0; 95% CI, 0.7-1.4). African American children had a higher readmission rate overall.

Conclusion: TRAP exposure is associated with increased odds of hospital readmission in white children, but not in African American children.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Recruitment diagram for children enrolled in the Greater Cincinnati Asthma Risks Study (August 2010 to October 2011)
Figure 2
Figure 2
Cox Regression Modeling of Time to Hospital Readmission for Asthma or Bronchodilator-Responsive Wheezing within 12 months by Race (African American or White) and by TRAP exposure, N=680
See this image and copyright information in PMC

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