Proximity to major roadways and asthma symptoms in the School Inner-City Asthma Study

doi:10.1016/j.jaci.2019.08.038

Journal of Allergy and Clinical Immunology

Volume 145, Issue 1, January 2020, Pages 119-126.e4

https://doi.org/10.1016/j.jaci.2019.08.038 Get rights and content

Background

Traffic proximity has been associated with adverse respiratory health outcomes. Less is known about the combined impact of residential and school exposures on pediatric asthma.

Objective

We sought to use spatial analysis methodology to analyze residential and school proximity to major roadways and pediatric asthma morbidity.

Methods

The School Inner-City Asthma Study (n = 350) recruited school-aged children with asthma. Each participant's school and home addresses were geocoded, and distances from major roadways were measured to calculate a composite measure accounting for both home and school traffic exposure. Generalized estimating equation models were clustered by subject and adjusted for age, race/ethnicity, sex, income, environmental tobacco smoke, controller medication, upper respiratory tract infections, and seasonality.

Results

The majority of participants (62%) attended schools within 100 m from major roadways, and 40% also resided within 100 m of major roadways. In multivariate analyses major roadway proximity was independently associated with increased asthma symptom days. At greater than the threshold of 100 m, children had 29% less odds of a symptom day over the past 2 weeks for each 100-m increase in distance from a major roadway (odds ratio, 0.71; 95% CI, 0.58-0.87; P < .01). Children farther from a major roadway also had significantly less reported health care use (odds ratio, 0.63; 95% CI, 0.47-0.85; P < .01) and were significantly less likely to have poor asthma control (odds ratio, 0.80; 95% CI, 0.69-0.94; P < .01). There was not a meaningful association between distance to a major roadway and lung function outcomes.

Conclusions

Proximity to a major roadway, a composite measure of home and school exposure but primarily driven by home exposure, was associated with greater asthma morbidity. More studies are needed to evaluate the independent effect of school distance to a roadway on asthma morbidity.

Graphical abstract

Section snippets

Methods

The School Inner-City Asthma Study is a 5-year prospective cohort study of children with asthma attending urban public elementary schools in the northeastern United States from 2008-2013. Detailed methods and characteristics of this cohort have been published previously.³⁷ Briefly, screening questionnaires were distributed each spring in participating schools to identify eligible participants. Eligible study participants completed an initial clinical assessment during the summer before the next

Results

A total of 351 students with asthma from 38 schools participated in the baseline study visit. Of these, 350 participants with 1327 observations from 37 schools, 36 discrete locations, had complete data collected and were included in the analyses. Table I presents baseline characteristics of the study population. Two hundred eighty-two participants with 707 observations had study observations conducted during each subject's academic school year. The mean age of the study population was

Discussion

In this longitudinal cohort study of urban school-aged children with asthma, a composite measure of residential and school proximity to major roadways was significantly associated with increased asthma symptom days, health care use, and poor asthma control independent of other known risk factors. These results highlight the important relationships between exposure to major roadways and asthma morbidity in urban school-aged children. Although environmental studies often focus only on the home

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In addition, neighbourhood traffic which was reported to trend from high to low was associated with the likelihood to be in a group with decreasing asthma symptoms from high to moderate. There have been similar reports on the association between neighbourhood traffic volume and asthma (Commodore et al., 2021; Feng and Astell-Burt, 2017b) and between living close to a major roadway or traffic-related facilities and asthma among children (Freid et al., 2021; Hauptman et al., 2020; Liu et al., 2020). Neighbourhood heavy traffic conditions and living close to a major roadway can be an indication of potential exposure to air-related pollution.
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: Supported by National Institutes of Health (NIH) grants R01AI073964 (to W.P.), R01AI073964-02S1 (to W.P.), K24AI106822 (to W.P.), U10HL098102 (to W.P.), U01AI110397 (to W.P.), U19AR06952 (to W.P.), 1R01HL137192 (to W.P.), K23AI106945 (to J.M.G.), K23AI104780 (to W.J.S.), K23ES023700 (to P.S.L.), P01 ES009825 (to D.R.G.), 1U19AR069525 (to W.P. and M.H.), and P30ES000002 (to D.R.G. and M.H.) and United States Environmental Protection Agency (USEPA) grant RD-83479801. This work was also supported in part by the American College of Allergy, Asthma & Immunology Young Faculty Award; a Boston Children's Hospital Division of Immunology Clinical Research Advisory Group Research Grant; and the Allergy and Asthma Awareness Initiative. This work was conducted with support from Harvard Catalyst/Harvard Clinical and Translational Science Center (NIH award no. UL1TR001102) and financial contributions from Harvard University and its affiliated academic healthcare centers. This work was also funded in part by cooperative agreement award number FAIN: U61TS000237 from the Agency for Toxic Substances and Disease Registry (ATSDR). The USEPA supports the Pediatric Environmental Health Specialty Units by providing partial funding to the ATSDR under Inter-Agency Agreement no. DW-75-92301301. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Harvard Catalyst, Harvard University, and its affiliated academic health care centers; the National Center for Research Resources; or the NIH. Its contents are solely the responsibility of the grantee and do not necessarily represent the official views of the ATSDR or USEPA. Furthermore, USEPA or ATSDR do not endorse the purchase of any commercial products or services mentioned in the publication. Supplies were generously donated or discounted as follows: Lincoln Diagnostics (Decatur, Ill) donated Multi-Test II devices and Greer Laboratories (Lenoir, NC) donated allergenic extracts for skin testing. Aspects of this manuscript were presented at the 2017 Pediatric Academic Societies Meeting; M.H. was awarded the 2017 Academic Pediatric Association's Michael Shannon Research Award for this work.

: Disclosure of potential conflict of interest: The authors declare that they have no relevant conflicts of interest.

: Clinical Trial Registration NCT01756391.

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Asthma and lower airway diseaseProximity to major roadways and asthma symptoms in the School Inner-City Asthma Study

Background

Objective

Methods

Results

Conclusions

Graphical abstract

Section snippets

Methods

Results

Discussion

J Pediatr

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Ann Allergy Asthma Immunol

Chest

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Ann Allergy Asthma Immunol

Int Immunopharmacol

J Allergy Clin Immunol

J allergy Clin Immunol Pract

J Allergy Clin Immunol

Ann Allergy Asthma Immunol

Health Place

The global burden of respiratory disease-impact on child health

Pediatr Pulmonol

Characteristics of inner-city children with asthma: the National Cooperative Inner-City Asthma Study

Pediatr Pulmonol

Section on Allergy and Immunology, Council on Environmental Health. Indoor environmental control practices and asthma management

Pediatrics

Aeroallergen exposure in the elementary school setting

Ann Allergy

Childhood incident asthma and traffic-related air pollution at home and school

Environ Health Perspect

Mouse and cockroach allergens in the dust and air in northeastern United States inner-city public high schools

Indoor Air

Allergens in urban schools and homes of children with asthma

Pediatr Allergy Immunol

Association between allergen exposure in inner-city schools and asthma morbidity among students

JAMA Pediatr

Near-highway pollutants in motor vehicle exhaust : a review of epidemiologic evidence of cardiac and pulmonary health risks

Environ Health

Childhood asthma and exposure to traffic and nitrogen dioxide

Epidemiology

Costs of childhood asthma due to traffic-related pollution in two California communities

Eur Respir J

Asthma and lower airway disease
Proximity to major roadways and asthma symptoms in the School Inner-City Asthma Study

Near-highway pollutants in motor vehicle exhaust : a review of epidemiologic evidence of cardiac and pulmonary health risks