We quantified the association between long-term exposure to air pollution and the incidence of asthma by conducting a systematic review and meta-analysis of cohort studies. Incidence was defined as the incidence of diagnosed asthma or of new wheeze symptom between two assessments or, in birth cohorts followed up to 10 years of age, a lifetime prevalence estimate of asthma or wheeze symptom. We identified 17 cohorts (eight birth cohorts and nine child/adult cohorts) with a total of 99 population-based risk estimates. The studies were heterogeneous in their design and methods of measurement. Follow-up ranged from 3 to 23 years. Most studies were based on within-community exposure contrasts dominated by traffic pollution. Twelve of the cohorts reported at least one positive statistically significant association between air pollution and a measure of incidence. Of the total of 99 estimates, only a minority (29) were positive and statistically significant. Estimates for meta-analysis were chosen a priori using a protocol. For the 13 studies with estimates for nitrogen dioxide (NO2), the random effects odds ratio was 1.07 (95% CI 1.02 to 1.13) per 10 μg/m3. For five studies with estimates for particulate matter with aerodynamic diameter <2.5 μm (PM2.5), the random effects estimate was 1.16 (95% CI 0.98 to 1.37) per 10 μg/m3. These estimates were reduced in size and statistical significance by adjustment for publication bias but remained positive. The results are consistent with an effect of outdoor air pollution on asthma incidence. Future meta-analyses would benefit from greater standardisation of cohort methods.
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We gratefully acknowledge the support of Mary Field-Smith in the preparation of the paper for publication and the encouragement of the Health Protection Agency Air Quality Unit (Head—Professor Robert Maynard) in developing this study.
The study was funded by the Policy Research Unit of the UK Department of Health. The views expressed in this paper are those of the authors alone and do not necessarily reflect those of the Department of Health.
Electronic supplementary material
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Details of literature search (PDF 23 kb)
Pollutant conversions and scaling factors (PDF 49 kb)
Mapping of reported outcomes to categories for analysis (PDF 14 kb)
Algorithms and rules for selecting estimates for meta-analysis (PDF 20 kb)
Details of birth cohorts (PDF 31 kb)
Details of child/adult cohorts (PDF 29 kb)
Details of individual estimates by pollutant and cohort (PDF 612 kb)
Cohort studies of air pollution and the incidence of asthma and wheeze symptom. Frequency of estimates and of their direction and statistical significance (PDF 136 kb)
Publication bias analyses for the estimates selected for the main meta-analyses of NO2 and PM2.5. (PDF 79 kb)
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Anderson, H.R., Favarato, G. & Atkinson, R.W. Long-term exposure to air pollution and the incidence of asthma: meta-analysis of cohort studies. Air Qual Atmos Health 6, 47–56 (2013). https://doi.org/10.1007/s11869-011-0144-5
- Air pollution
- Asthma incidence