177512 Ambient air pollution is associated with an increased risk for respiratory illness, stunting, and anemia in young Ecuadorian children

Monday, October 27, 2008

Aaron Michael Harris, BA , Department of Public Health and Family Medicine, Tufts University School of Medicine, Boston, MA
Mark Woodin , Civil & Environmental Engineering, Tufts University, Medford, MA
John L. Durant, PhD, MS, BS , Civil and Environmental Engineering, Tufts University, Medford, MA
Elena Naumova, PhD , Department of Public Health and Community Medicine, Tufts School of Medicine, Boston, MA
Bertha Estrella, MD , Corporación Ecuatoriana de Biotecnología, Quito, Ecuador
Fernando Sempertegui, MD , Corporación Ecuatoriana de Biotecnología, Quito, Ecuador
Jeffrey K. Griffiths, MD, MPH & TM , Department of Public Health and Family Medicine, Tufts University School of Medicine, Boston, MA
Purpose. Pneumonia is the leading cause of death in children under 5 years; risk factors include air pollution and malnutrition.

Hypothesis. We hypothesized that air pollution increases the risk of developing a respiratory illness and is associated with increased malnutrition such as stunting and anemia.

Methods. We identified two socio-economically matched study sites in Quito, Ecuador that differed only in mean daily air particulate matter and nitrogen dioxide exposure. In a retrospective cohort study, we enrolled 825 children (408 low exposure, 413 high exposure neighborhoods). For each child we obtained 1) Anthropometric data; 2) Medical history including physician visits or hospitalizations for respiratory illness in the prior year; and 3) Blood hemoglobin levels and pulse-oximetry.

Results. High-exposure children had a significantly higher risk of physician consultation for respiratory illness (OR=1.62; 95% CI 1.22-2.16), and multivariate analysis showed an increased risk of hospitalization for pneumonia (OR=3.40, 95% CI 1.04-11.11). These children were at significantly higher risk of being stunted (OR=1.88; 95% CI 1.36-2.60, p <0.001), or anemic (OR=1.45; 95% CI 1.09-1.93, p=0.013). Children in the high exposure site had lower blood oxygen saturations (mean 92% + 3% vs 96% + 2%, p < 0.001), consistent with high pediatric carboxyhemoglobin levels previously reported from high air pollution areas of Quito.

Conclusions. Air pollution is associated with an increased risk for respiratory illness, stunting, and anemia in young Ecuadorian children. We suspect that increased respiratory illness incrementally adversely affects nutritional status. Decreasing air pollution exposures may improve both respiratory and nutritional health.

Learning Objectives:
1. List 3 important health consequences as a result of living in a city with poor air quality. 2. Identify sources of air pollution. 3. Develop possible policies for decreasing environmental exposure to air pollutants in urban settings.

Keywords: Air Quality, Environmental Exposures

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have no conflicts of interest.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.