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Estimate the effects of environmental determining factors on childhood asthma hospital admissions in Lisbon, Portugal: a time series modelling study

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Abstract

Several epidemiological studies have shown the relationship between hospital admissions associated with asthma, meteorological variables, and exposure to outdoor air pollution. In this study, we propose to evaluate the effects of environmental variables on asthma admissions in the Lisbon Metropolitan Area, Portugal. A quasi-Poisson generalized additive model combined with a distributed lag non-linear model (DLNM) was applied to estimate the delayed effects of environmental variables on childhood asthma admissions from 2009 to 2015. Subgroup analyses by sex and age were performed. We found that an increase of 1 μg/m3 of PM10 was associated with an increased risk of asthma-related hospital admission, on the order of 2% (RR = 1.02; CI 95% 1.01–1.03). There was an increase of 4% associated with a rainfall (PP) increase of 1 mm (RR = 1.04; 95% CI 1.02–1.11). Among male children, the increase of PM10 concentration is associated with a 2% increase in the risk of hospital admission, while PP is associated with a 5% increase. PM10, Tmean, and Tmax are significantly associated at lags 0–3 months, for age group 5–9 years, with a cumulative effect of RR = 1.03; 95% CI (1.01–1.05); RR = 1.54; 95% CI (1.19–1.99); and RR = 0.67; 95% CI (0.54–0.84) at lag 0, respectively. For age group 10–14 years, only relative humidity (RH) was significantly associated with hospital admissions; an increased risk was with higher relative humidity and short term (lag 0). Our results provide evidence of the adverse effects of PM10, PP, and RH on childhood asthma. These variables are good predictors of asthma. The risk of hospital admission with a primary diagnosis of asthma is more frequent during the autumn, when the school year begins. These findings will be important for health authorities as they provide epidemiological evidence for developing prevention strategies to reduce the risk of childhood asthma hospitalizations.

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Acknowledgments

The authors wish to thank the Central Administration of the Health System (ACSS, Administração Central do Sistema de Saúde) for providing the data for this analysis and FCT for funds to GHTM-UID/04413/2020. The authors also thank to the Professor Inês Fronteira (IHMT/UNL).

Funding

This study is partially financed by national funds through FCT—Foundation for Science and Technology—under project UIDB/00297/2020.

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Authors and Affiliations

  1. International Public Health and Biostatistics Department, Institute of Hygiene and Tropical Medicine, NNOVA University of Lisbon (IHMT – UNL), Lisbon, Portugal

    Mónica Rodrigues

  2. Centre for Mathematics and Applications (CMA), Department of Mathematics – Faculty of Sciences and Technology, NOVA University of Lisbon, Lisbon, Portugal

    Isabel Natário

  3. Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon (IHMT - UNL), Lisbon, Portugal

    Maria do Rosário de Oliveira Martins

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  1. Mónica Rodrigues
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Contributions

Mónica Rodrigues: conceptualization and designed the study, investigation, data curation, methodology, resources, software, formal analysis, writing—original draft, writing—review and editing. Isabel Natário: investigation, methodology, writing—review and editing. Maria do Rosário de Oliveira Martins: resources, investigation, methodology; writing—review and editing. All authors have read and agree to the published version of the manuscript.

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Correspondence to Mónica Rodrigues.

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Rodrigues, M., Natário, I. & do Rosário de Oliveira Martins, M. Estimate the effects of environmental determining factors on childhood asthma hospital admissions in Lisbon, Portugal: a time series modelling study. Theor Appl Climatol 143, 809–821 (2021). https://doi.org/10.1007/s00704-020-03415-w

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