Proximity to Major Roads and Risks of Childhood Recurrent Wheeze and Asthma in a Severe Bronchiolitis Cohort
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population and Data Collection
2.2. Exposure Assessment
2.3. Outcome Assessment
2.4. Statistical Analyses
3. Results
3.1. Study Population
3.2. Exposure Results
3.3. Outcome Results
4. Discussion
4.1. Overall Findings
4.2. High-Risk Cohort Comparison
4.3. General Population Comparison
4.4. Synergistic Effects of TRAP
4.5. Study Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | Total (n = 920), n (%) | Pooled Proximity to Major Road before Age 3 Years, Meters | ||||
---|---|---|---|---|---|---|
<100 (n = 58), n (%) | 100–200 (n = 82), n (%) | 201–300 (n = 101), n (%) | >300 (n = 679), n (%) | p-Value * | ||
Age at enrollment, months | 0.19 | |||||
<2 | 271 (29) | 19 (33) | 16 (20) | 33 (33) | 203 (30) | |
≥2 | 649 (71) | 39 (67) | 66 (80) | 68 (67) | 476 (70) | |
Sex | 0.18 | |||||
Male | 552 (60) | 29 (50) | 44 (54) | 65 (64) | 414 (61) | |
Female | 368 (40) | 29 (50) | 38 (46) | 36 (36) | 265 (39) | |
Race/ethnicity | <0.001 | |||||
Non-Hispanic white | 400 (43) | 19 (33) | 30 (37) | 48 (47) | 303 (45) | |
Non-Hispanic black | 210 (23) | 20 (34) | 33 (40) | 26 (26) | 131 (19) | |
Hispanic | 275 (30) | 15 (26) | 17 (21) | 27 (27) | 216 (32) | |
Other | 35 (4) | 4 (7) | 2 (2) | 0 (0) | 29 (4) | |
Health insurance | 0.46 | |||||
Non-private (e.g., public or none) | 547 (60) | 40 (69) | 46 (58) | 62 (61) | 399 (59) | |
Private | 371 (40) | 18 (31) | 34 (42) | 39 (39) | 280 (41) | |
Median household income estimated by ZIP code at enrollment | 0.93 | |||||
<$50,000 | 481 (52) | 32 (55) | 41 (50) | 54 (53) | 354 (52) | |
≥$50,000 | 439 (48) | 26 (45) | 41 (50) | 47 (47) | 325 (48) | |
Mother’s age at enrollment, years | 0.51 | |||||
<25 | 289 (31) | 23 (40) | 28 (34) | 29 (29) | 209 (31) | |
25–29 | 263 (29) | 12 (20) | 24 (30) | 34 (34) | 193 (29) | |
30–34 | 218 (24) | 11 (19) | 15 (18) | 20 (20) | 172 (25) | |
≥35 | 148 (16) | 12 (21) | 15 (18) | 17 (17) | 104 (15) | |
Mode of delivery | 0.59 | |||||
Vaginal delivery | 596 (66) | 41 (73) | 56 (68) | 64 (65) | 435 (65) | |
Cesarean section | 312 (34) | 15 (27) | 26 (32) | 34 (35) | 237 (35) | |
Premature birth (gestational age ≤37 weeks) | 170 (18) | 13 (22) | 13 (16) | 21 (21) | 123 (18) | 0.71 |
Infant tobacco exposure at enrollment | 138 (15) | 3 (5) | 13 (16) | 19 (19) | 103 (15) | 0.13 |
Parental history of asthma | 305 (33) | 19 (33) | 29 (35) | 32 (32) | 225 (33) | 0.91 |
Parental history of eczema | 175 (19) | 18 (31) | 15 (18) | 21 (21) | 121 (18) | 0.09 |
Characteristics | Polled Proximity to Primary Road before Age 3 Years, Meters | |||
---|---|---|---|---|
<400 (n = 34), n (%) | 400–1000 (n = 93), n (%) | >1000 (n = 793), n (%) | p-Value * | |
Age at enrollment, months | 0.25 | |||
<2 | 13 (38) | 22 (24) | 236 (30) | |
≥2 | 21 (62) | 71 (76) | 557 (70) | |
Sex | 0.77 | |||
Male | 20 (59) | 59 (63) | 473 (60) | |
Female | 14 (41) | 34 (37) | 320 (40) | |
Race/ethnicity | 0.02 | |||
Non-Hispanic white | 13 (38) | 27 (29) | 360 (45) | |
Non-Hispanic black | 8 (24) | 32 (34) | 170 (22) | |
Hispanic | 12 (35) | 33 (36) | 230 (29) | |
Other | 1 (3) | 1 (1) | 33 (4) | |
Health insurance | 0.02 | |||
Non-private (e.g., public or none) | 18 (55) | 68 (73) | 461 (58) | |
Private | 15 (45) | 25 (27) | 331 (42) | |
Median household income estimated by ZIP code at enrollment | 0.001 | |||
<$50,000 | 25 (74) | 60 (65) | 396 (50) | |
≥$50,000 | 9 (26) | 33 (35) | 397 (50) | |
Mother’s age at enrollment, years | 0.23 | |||
<25 | 13 (38) | 38 (41) | 238 (30) | |
25–29 | 9 (26) | 26 (28) | 228 (29) | |
30–34 | 5 (15) | 20 (21) | 193 (24) | |
≥35 | 7 (21) | 9 (10) | 132 (17) | |
Mode of delivery | 0.72 | |||
Vaginal delivery | 23 (68) | 63 (69) | 510 (65) | |
Cesarean section | 11 (32) | 28 (31) | 273 (35) | |
Premature birth (gestational age ≤ 37 weeks) | 6 (18) | 19 (20) | 145 (18) | 0.87 |
Infant tobacco exposure at enrollment | 3 (9) | 18 (19) | 117 (15) | 0.30 |
Parental history of asthma | 11 (32) | 35 (38) | 259 (33) | 0.70 |
Parental history of eczema | 4 (12) | 21 (23) | 150 (19) | 0.49 |
Road Exposures | Total (n = 920) | Without Recurrent Wheeze by Age 3 Years (n = 624) | With Recurrent Wheeze by Age 3 Years (n = 296) | p-Value * | |
---|---|---|---|---|---|
Number of participants who moved, n (%) | 329 (36) | 264 (42) | 65 (22) | <0.001 | |
Number of moves per participant, median (IQR) | 1 (1–2) | 1 (1–2) | 1 (1–1) | <0.001 | |
Average length of stay in each address in days, median (IQR) | 548 (355–1095) | 559 (428–1095) | 337 (233–494) | <0.001 | |
Birth distance to major roads in meter, median (IQR) | 550 (234–1135) | 576 (240–1159) | 474 (207–1067) | 0.30 | |
Pooled distance to major roads in meter, median (IQR) | 565 (257–1141) | 583 (274–1162) | 526 (238–1078) | 0.31 | |
Birth distance to primary roads in meters, median (IQR) | 3004 (1290–6273) | 3018 (1277–6326) | 2969 (1333–6206) | 0.97 | |
Pooled distance to primary roads in meters, median (IQR) | 3266 (1391–7189) | 3345 (1396–7522) | 3120 (1388–6911) | 0.76 | |
Birth major road density in km roadways/km2 land area, median (IQR) † | 5 (4–9) | 5 (4–9) | 5 (4–9) | 0.63 | |
Pooled major road density in km roadways/km2 land area, median (IQR) †,§ | 4 (3–7) | 4 (2–7) | 5 (3–8) | 0.04 | |
Birth primary road density in km roadways/km2 land area, median (IQR) † | 6 (3–11) | 6 (3–9) | 11 (3–17) | 0.14 | |
Pooled primary road density in km roadways/km2 land area, median (IQR) †,§ | 4 (2–7) | 4 (2–7) | 4 (4–14) | 0.07 | |
Birth population density in population/mile2 land area, median (IQR) ‡ | 4456 (1795–10,756) | 4174 (1560–10,744) | 5068 (2066–11,325) | 0.64 | |
Pooled population density in (population/mile2 land area, median (IQR) ‡,§ | 4546 (1935–10,100) | 4486 (1896–10,047) | 5147 (2057–10,603) | 0.93 | |
Birth distance to major roads, meters | <100 | 85 (9) | 47 (8) | 38 (13) | 0.07 |
100–200 | 116 (13) | 82 (13) | 34 (12) | ||
201–300 | 86 (9) | 61 (10) | 25 (8) | ||
>300 | 632 (69) | 433 (70) | 199 (67) | ||
Birth distance to primary roads, meters | <400 | 59 (6) | 45 (7) | 14 (5) | 0.34 |
400–1000 | 114 (12) | 78 (13) | 36 (12) | ||
>1000 | 746 (81) | 500 (80) | 246 (83) | ||
Pooled distance to major roads, meters § | <100 | 69 (8) | 37 (6) | 32 (11) | 0.06 |
100–200 | 95 (10) | 63 (10) | 32 (11) | ||
201–300 | 101 (11) | 69 (11) | 32 (11) | ||
>300 | 655 (71) | 455 (73) | 200 (67) | ||
Pooled distance to primary roads, meters § | <400 | 46 (5) | 33 (5) | 13 (4) | 0.81 |
400–1000 | 103 (11) | 71 (12) | 32 (11) | ||
>1000 | 771 (84) | 520 (83) | 251 (85) |
Road Exposures | Total (n = 858) | without Asthma by Age 5 Years (n = 623) | with Asthma by Age 5 Years (n = 235) | p-Value * | |
---|---|---|---|---|---|
Number of participants who moved, n (%) | 413 (48) | 288 (46) | 125 (53) | 0.07 | |
Number of moves per participant, median (IQR) | 1 (1–2) | 1 (1–2) | 2 (1–2) | 0.04 | |
Average length of stay in each address in days, median (IQR) | 1095 (548–1095) | 1095 (548–1095) | 548 (548–1095) | 0.05 | |
Birth distance to major roads in meter, median (IQR) | 540 (236–1121) | 601 (253–1177) | 425 (211–960) | 0.006 | |
Pooled distance to major roads in meter, median (IQR) | 601 (285–1199) | 651 (305–1218) | 507 (233–1082) | 0.005 | |
Birth distance to primary roads in meter, median (IQR) | 3004 (1283–6275) | 3167 (1301–6398) | 2500 (1197–5885) | 0.15 | |
Pooled distance to primary roads in meter, median (IQR) | 3430 (1491–7765) | 3558 (1516–8429) | 2908 (1483–6574) | 0.14 | |
Birth major road density in km roadways/km2 land area, median (IQR) † | 5 (4–9) | 5 (4–9) | 6 (4–10) | 0.61 | |
Pooled major road density in km roadways/km2 land area, median (IQR) †,§ | 4 (2–7) | 4 (2–6) | 4 (2–8) | 0.58 | |
Birth primary road density in km roadways/km2 land area, median (IQR) † | 6 (3–11) | 6 (3–8) | 9 (3–21) | 0.35 | |
Pooled primary road density in km roadways/km2 land area, median (IQR) †,§ | 4 (2–6) | 4 (2–6) | 2 (1–8) | 0.64 | |
Birth population density in population/m2 land area, median (IQR) ‡ | 4432 (1817–10,611) | 3954 (1698–9615) | 5713 (2075–13,244) | 0.01 | |
Pooled population density in (population/mile2 land area, median (IQR) ‡,§ | 4590 (2008–9793) | 4210 (1961–9004) | 6256 (2203–12,776) | 0.005 | |
Birth distance to major roads, meters | <100 | 82 (10) | 55 (9) | 27 (11) | 0.08 |
100–200 | 105 (12) | 75 (12) | 30 (13) | ||
201–300 | 81 (9) | 51 (8) | 30 (13) | ||
>300 | 589 (69) | 442 (71) | 147 (63) | ||
Birth distance to primary roads, meters | <400 | 55 (6) | 37 (6) | 18 (8) | 0.59 |
400–1000 | 108 (13) | 77 (12) | 31 (13) | ||
>1000 | 694 (81) | 509 (82) | 185 (79) | ||
Pooled distance to major roads, meters § | <100 | 55 (6) | 35 (6) | 20 (9) | 0.08 |
100–200 | 74 (9) | 53 (8) | 21 (8) | ||
201–300 | 96 (11) | 62 (10) | 34 (14) | ||
>300 | 633 (74) | 473 (76) | 160 (69) | ||
Pooled distance to primary roads, meters § | <400 | 31 (4) | 22 (3) | 9 (4) | 0.83 |
400–1000 | 87 (10) | 61 (10) | 26 (11) | ||
>1000 | 740 (86) | 540 (87) | 200 (5) |
Road Exposures | Unadjusted HR (95% CI) | p-Value | Adjusted HR (95% CI) * | p-Value | |
---|---|---|---|---|---|
Birth distance to major road, meter | <100 | 1.53 (1.08–2.16) | 0.02 | 1.43 (1.00–2.04) | 0.05 |
100–200 | 0.96 (0.66–1.38) | 0.81 | 0.91 (0.63–1.31) | 0.60 | |
201–300 | 0.93 (0.61–1.41) | 0.74 | 0.95 (0.62–1.44) | 0.80 | |
>300 | Ref | --- | Ref | --- | |
Birth distance to primary road, meter | <400 | 0.69 (0.41–1.19) | 0.19 | 0.72 (0.42–1.24) | 0.24 |
400–1000 | 0.91 (0.64–1.29) | 0.58 | 0.89 (0.62–1.27) | 0.51 | |
>1000 | Ref | --- | Ref | --- | |
Pooled distance to major road, meter † | <100 | 1.72 (1.18–2.50) | 0.004 | 1.59 (1.08–2.33) | 0.02 |
100–200 | 1.21 (0.84–1.76) | 0.31 | 1.14 (0.78–1.66) | 0.51 | |
201–300 | 1.04 (0.71–1.51) | 0.85 | 1.03 (0.71–1.50) | 0.88 | |
>300 | Ref | --- | Ref | --- | |
Pooled distance to primary road, meter † | <400 | 0.90 (0.52–1.57) | 0.72 | 0.92 (0.53–1.62) | 0.78 |
400–1000 | 0.91 (0.63–1.31) | 0.62 | 0.89 (0.61–1.29) | 0.53 | |
>1000 | Ref | --- | Ref | --- |
Road Exposures | Unadjusted OR (95%CI) | p-Value | Adjusted OR (95%CI) * | p-Value | |
---|---|---|---|---|---|
Birth distance to major road, meter | <100 | 1.48 (0.98–2.22) | 0.06 | 1.26 (0.81–1.95) | 0.31 |
100–200 | 1.20 (0.75–1.93) | 0.44 | 0.95 (0.65–1.38) | 0.78 | |
201–300 | 1.77 (1.11–2.82) | 0.02 | 1.62 (0.92–2.85) | 0.10 | |
>300 | Ref | --- | Ref | --- | |
Birth distance to primary road, meter | <400 | 1.34 (0.54–3.30) | 0.53 | 1.13 (0.53–2.41) | 0.76 |
400–1000 | 1.11 (0.81–1.52) | 0.53 | 0.95 (0.64–1.39) | 0.78 | |
>1000 | Ref | --- | Ref | --- | |
Pooled distance to major road, meter † | <100 | 1.69 (1.09–2.61) | 0.02 | 1.51 (1.00–2.28) | 0.05 |
100–200 | 1.17 (0.81–1.69) | 0.40 | 0.85 (0.54–1.34) | 0.49 | |
201–300 | 1.62 (1.10–2.39) | 0.02 | 1.62 (1.16–2.25) | 0.005 | |
>300 | Ref | --- | Ref | --- | |
Pooled distance to primary road, meter † | <400 | 1.11 (0.33–3.71) | 0.87 | 1.07 (0.39–2.95) | 0.89 |
400–1000 | 1.15 (0.80–1.65) | 0.45 | 1.03 (0.69–1.55) | 0.87 | |
>1000 | Ref | --- | Ref | --- |
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Freid, R.D.; Qi, Y.; Espinola, J.A.; Cash, R.E.; Aryan, Z.; Sullivan, A.F.; Camargo, C.A., Jr. Proximity to Major Roads and Risks of Childhood Recurrent Wheeze and Asthma in a Severe Bronchiolitis Cohort. Int. J. Environ. Res. Public Health 2021, 18, 4197. https://doi.org/10.3390/ijerph18084197
Freid RD, Qi Y, Espinola JA, Cash RE, Aryan Z, Sullivan AF, Camargo CA Jr. Proximity to Major Roads and Risks of Childhood Recurrent Wheeze and Asthma in a Severe Bronchiolitis Cohort. International Journal of Environmental Research and Public Health. 2021; 18(8):4197. https://doi.org/10.3390/ijerph18084197
Chicago/Turabian StyleFreid, Rachel D., Ying (Shelly) Qi, Janice A. Espinola, Rebecca E. Cash, Zahra Aryan, Ashley F. Sullivan, and Carlos A. Camargo, Jr. 2021. "Proximity to Major Roads and Risks of Childhood Recurrent Wheeze and Asthma in a Severe Bronchiolitis Cohort" International Journal of Environmental Research and Public Health 18, no. 8: 4197. https://doi.org/10.3390/ijerph18084197