Ozone exposure is positively correlated with the occurrence of Kawasaki disease in Chinese children

Abstract

Background: We studied whether ozone (O₃) exposure will affect the occurrence of KD, in Xiamen.

Methods: A time-stratified case-crossover design was conducted to explore the relationship between O₃ exposure and KD in children. A total of 604 participants from 2017 to 2024 were included. Artificial intelligence technology combined with large data model was used to calculate O₃ concentration, and O₃ exposure was assigned to each participant. Poisson generalized additive model was used to calculate the risk effect of O₃ and KD. Correlation and mediation analysis were used to study the mechanism of KD.

Results: When lag 2 to 6 days, O₃ exposure will increase the occurrence of KD. On the 4th day of lag, O₃ led to the highest risk of KD, relative risk(RR) = 1.09(95%CI = 1.008, 1.19). The results of mediation analysis showed that clinical indicators such as white blood cell (WBC), neutrophil (NEUT), and C-reactive protein (CRP) were the main mediators regulating the association between O₃ and KD.

Conclusion: Our results show that exposure to O₃ is a potential risk factor for KD in children, and clinical indicators such as WBC, NEUT, PLT and CRP are the main mediators regulating O₃ and KD.

Impact: We studied the association between O₃ exposure and the incidence of KD, and further analyzed the regulatory role of clinical indicators in this association. On the 4th day of lag, O₃ led to the highest risk of KD, RR = 1.09(95%CI = 1.008,1.19). The relationship between O₃ exposure and KD is mainly mediated by clinical indicators such as WBC, NEUT, PLT and CRP. Our findings explain the association between O3 exposure and the incidence of KD, and further analyze the regulatory role of clinical indicators in the association. It is helpful to provide theoretical support for subsequent research.