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Repeated respiratory hospital encounters among children with asthma and residential proximity to traffic
  1. J Chang1,
  2. R J Delfino1,
  3. D Gillen2,
  4. T Tjoa1,
  5. B Nickerson3,
  6. D Cooper4
  1. 1
    Department of Epidemiology, School of Medicine, University of California, Irvine, Irvine, California, USA
  2. 2
    Department of Statistics, School of Information and Computer Sciences, University of California, Irvine, Irvine, California, USA
  3. 3
    Division of Pulmonary Medicine, Children’s Hospital of Orange County, Orange, California, USA
  4. 4
    Department of Pediatrics, School of Medicine, University of California, Irvine, Irvine, California, USA
  1. Dr Ralph J Delfino, Department of Epidemiology, School of Medicine, University of California, Irvine, 100 Theory, Suite 100, Irvine, CA 92617–7555, USA; rdelfino{at}


Objective: The prevalence of adverse respiratory outcomes among children has been frequently associated with measurements of traffic-related exposures, and other data suggest asthma severity is worsened with residence near heavy traffic. We examined the association between neighbourhood traffic burden and repeated acute respiratory illnesses that required emergency department visits and/or hospitalisation for children with a primary or secondary diagnosis of asthma (89% acute bronchitis or pneumonia).

Methods: This is a hospital-based longitudinal study of a southern California urban catchment area around two adjacent children’s hospitals. Subjects’ home addresses were geocoded and linked to nearby traffic data. Recurrent event proportional hazard analysis was used to estimate the hazard of repeated hospital encounters.

Results: We found living within 300 metres of arterial roads or freeways increased risk of repeated hospital encounters in 3297 children age 18 years or less. At highest risk were children in the top quintile of traffic density (HR = 1.21; 95% CL 0.99 to 1.49) and those who had 750 metres or more of arterial road and freeway length within 300 metres of their residence (HR = 1.18; 95% CL 0.99 to 1.41). Associations between repeated hospital encounters and residence near heavy traffic were stronger in females than males and in children without insurance or who required government sponsored insurance than children with private insurance. The gender disparity was most notable among infants (age 0) and children ages 6–18 years.

Conclusions: Results suggest exposure to traffic-related air pollution increases asthma severity as indicated by hospital utilisation. The finding in infants suggests this is an especially vulnerable population, although the validity of asthma diagnosis at this age is unknown. Females and children who do not have private insurance may also be more vulnerable to air pollution from traffic.

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  • Funding: The project described was supported by South Coast Air Management District (SCAQMD), through the University of California, Los Angeles, Asthma and Outdoor Air Quality Consortium (Contract No UCLA-040623), and grant number ES11615 from the National Institute of Environmental Health Sciences (NIEHS) and US National Institutes of Health (NIH) grants HL-080947 and HD-048721. Asthma surveillance data were collected under grant no FCI-CU3-13 from the Children and Families Commission of Orange County for the Asthma and Chronic Lung Disease Institute.

  • Competing interests: None.

  • Ethics approval: The institutional review boards of the University of California, Irvine, and Children’s Hospital of Orange County, approved the study protocol and establishment of the hospital records surveillance system for respiratory illnesses.

  • Disclaimer: Contents of this report are solely the responsibility of the authors and do not necessarily represent the official views of the NIEHS, NIH or SCAQMD.