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Air Pollution and Respiratory Infections during Early Childhood: An Analysis of 10 European Birth Cohorts within the ESCAPE Project
Open accessAbstract
Background: Few studies have investigated traffic-related air pollution as a risk factor for respiratory infections during early childhood. Objectives: We aimed to investigate the association between air pollution and pneumonia, croup, and otitis media in 10 European birth cohorts—BAMSE (Sweden), GASPII (Italy), GINIplus and LISAplus (Germany), MAAS (United Kingdom), PIAMA (the Netherlands), and four INMA cohorts (Spain)—and to derive combined effect estimates using meta-analysis. Methods: Parent report of physician-diagnosed pneumonia, otitis media, and croup during early childhood were assessed in relation to annual average pollutant levels [nitrogen dioxide (NO2), nitrogen oxide (NOx), particulate matter ≤ 2.5 μm (PM2.5), PM2.5 absorbance, PM10, PM2.5–10 (coarse PM)], which were estimated using land use regression models and assigned to children based on their residential address at birth. Identical protocols were used to develop regression models for each study area as part of the ESCAPE project. Logistic regression was used to calculate adjusted effect estimates for each study, and random-effects meta-analysis was used to calculate combined estimates. Results: For pneumonia, combined adjusted odds ratios (ORs) were elevated and statistically significant for all pollutants except PM2.5 (e.g., OR = 1.30; 95% CI: 1.02, 1.65 per 10-μg/m3 increase in NO2 and OR = 1.76; 95% CI: 1.00, 3.09 per 10-μg/m3 PM10). For otitis media and croup, results were generally null across all analyses except for NO2 and otitis media (OR = 1.09; 95% CI: 1.02, 1.16 per 10-μg/m3). Conclusion: Our meta-analysis of 10 European birth cohorts within the ESCAPE project found consistent evidence for an association between air pollution and pneumonia in early childhood, and some evidence for an association with otitis media. Citation: MacIntyre EA, Gehring U, Mölter A, Fuertes E, Klümper C, Krämer U, Quass U, Hoffmann B, Gascon M, Brunekreef B, Koppelman GH, Beelen R, Hoek G, Birk M, de Jongste JC, Smit HA, Cyrys J, Gruzieva O, Korek M, Bergström A, Agius RM, de Vocht F, Simpson A, Porta D, Forastiere F, Badaloni C, Cesaroni G, Esplugues A, Fernández-Somoano A, Lerxundi A, Sunyer J, Cirach M, Nieuwenhuijsen MJ, Pershagen G, Heinrich J. 2014. Air pollution and respiratory infections during early childhood: an analysis of 10 European birth cohorts within the ESCAPE project. Environ Health Perspect 122:107–113; http://dx.doi.org/10.1289/ehp.1306755
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“In a meta-analysis of multiple European birth cohorts, MacIntyre et al. [19] concluded there was consistent evidence for an association between air pollution and pneumonia in early childhood.”
From Air pollution and children’s health—a review of adverse effects associated with prenatal exposure from fine to ultrafine particulate matter (2021) · cites this paper as [19]
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Metadata
- Authors
- MacIntyre, E. A., Gehring, U., Mölter, A., Fuertes, E., Klümper, C., Krämer, U., Quass, U., Hoffmann, B., Gascon, M., Brunekreef, B., Koppelman, G. H., Beelen, R., Hoek, G., Birk, M., de Jongste, J. C., Smit, H. A., Cyrys, J., Gruzieva, O., Korek, M., Bergström, A., Agius, R. M., de Vocht, F., Simpson, A., Porta, D., Forastiere, F., Badaloni, C., Cesaroni, G., Esplugues, A., Fernández-Somoano, A., Lerxundi, A., Sunyer, J., Cirach, M., Nieuwenhuijsen, M. J., Pershagen, G., & Heinrich, J.
- Affiliations
- Helmholtz Munich (DE)
- Utrecht University (NL)
- Manchester Academic Health Science Centre (GB)
- University of British Columbia (CA)
- Leibniz Institute of Environmental Medicine (DE)
- Institut für Energie- und Umwelttechnik (DE)
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Catalonia, Spain
- University Medical Center Groningen (NL)
- Erasmus MC (NL)
- University Medical Center Utrecht (NL)
- Karolinska Institutet (SE)
- ASL Roma (IT)
- Department of Epidemiology, Lazio Regional Health Service ASL RME (Dipartimento di epidemiologia ASL Roma E), Rome, Italy
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (ES)
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain
- University of the Basque Country (ES)
- Universitat Pompeu Fabra (ES)
- Center for Research in Environmental Epidemiology (ES)
- Corresponding author
- Heinrich, Joachim
- ORCID
- Gehring, Ulrike
- Mölter, Anna
- Fuertes, Elaine
- Klümper, Claudia
- Krämer, Ursula
- Hoffmann, Barbara
- Brunekreef, Bert
- Koppelman, Gerard H.
- Hoek, Gerard
- Smit, H.A.
- Cyrys, Josef
- Gruzieva, Olena
- Korek, Michal
- Bergström, Anna
- Agius, Raymond M.
- de Vocht, Frank
- Simpson, Angela
- Porta, Daniela
- Forastiere, Francesco
- Cesaroni, Giulia
- Esplugues, Ana
- Sunyer, Jordi
- Cirach, Marta
- Nieuwenhuijsen, Mark J.
- Pershagen, Göran
- Heinrich, Joachim
- Venue
- Environmental Health Perspectives
- Publisher
- American Chemical Society (ACS)
- Published
- 2013-10-22
- Volume
- 122
- Issue
- 1
- Pages
- 107-113
- ISSN
- 0091-6765 (ISSN-L)
- 1552-9924
- PMC
- PMC3888562
- OpenAlex
- W2119195606
- Cited by
- 307
- References
- 43
- Citations by year
- 2026: 9 · 2025: 12 · 2024: 21 · 2023: 18 · 2022: 33 · 2021: 47 · 2020: 41 · 2019: 26 · 2018: 22 · 2017: 24 · 2016: 17 · 2015: 26 · 2014: 8 · 2013: 3
- FWCI
- 13.23
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- public-domain
- creativecommons.org/licenses/by/4.0/ (vor, 1529 d)
- Locations
- Environmental Health Perspectives (publishedVersion, public-domain)
- Europe PMC (PubMed Central) (publishedVersion, public-domain)
- PubMed Central (publishedVersion, public-domain)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, other-oa)
- RECERCAT (Consorci de Serveis Universitaris de Catalunya) (publishedVersion)
- Repositori digital de la UPF (Universitat Pompeu Fabra) (publishedVersion)
- Bristol Research (University of Bristol) (publishedVersion)
- Research Bank (Australian Catholic University) (submittedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- Consultation of the Doctoral Thesis Database (TESEO) (Ministerio de Educación, Cultura y Deporte) (submittedVersion, cc-by-nc-nd)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Site cant be reached (submittedVersion)
- Research Explorer (The University of Manchester) (submittedVersion, other-oa)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Funders
- Vårdalstiftelsen
- Asthma and Lung UK (04/014)
- European Commission (211250)
- Deutsche Forschungsgemeinschaft
- Svenska Forskningsrådet Formas
- Generalitat de Catalunya (00241, 1999SGR 0024 1)
- Eusko Jaurlaritza (2005111093, 2009111069)
- Ministero della Salute (502/92)
- Generalitat Valenciana
- Stockholms Läns Landsting
- Naturvårdsverket
- Vetenskapsrådet
- Helmholtz-Zentrum für Umweltforschung
- Universidad de Oviedo
- Bundesministerium für Bildung, Wissenschaft, Forschung und Technologie
- Medical Research Council (G0601361)
- Instituto de Salud Carlos III (05/1052, FIS‐ PI081151, 06/1213, PI/04/2018, FIS‐FEDER 03/1615, Red INMA G03/176, FISPI09/02311, FIS-PI06/0867, PI060867, 09/02647, CB06/02/0041, PI0902311, PI/08/1151, G03/176, 04/1509, 03/1615, FISPS09/ 00090, 07/0314, FIS‐PI042018, INMA G03/176, 04/1112, 04/1931, PS09/00090, 05/1079)
- Helmholtz Zentrum München
- Topics
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Air Quality and Health Impacts
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Indoor Air Quality and Microbial Exposure
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Asthma and respiratory diseases
- Keywords
- traffic-related air pollution, pediatric respiratory infection, pneumonia, otitis media, croup, nitrogen dioxide, particulate matter, PM2.5, PM10, early childhood, birth cohort, ESCAPE project, land use regression, residential air pollution exposure, effect estimates
- MeSH terms
- Air Pollutants, Air Pollution, Environmental Exposure, Female, Humans, Male, Models, Theoretical, Otitis Media, Pneumonia, Respiratory Tract Infections, Particulate Matter
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