association between kawasaki disease and exposure to air...
TRANSCRIPT
Association between Kawasaki Disease
and Exposure to Air Pollution
Chau-Ren Jung1,2, Wei-Ting Chen3,
Yu-Ting Lin1,2, and Bing-Fang Hwang2*
1Department of Public Health, China Medical University, Taiwan 2Department of Occupational Safety and Health, China Medical
University, Taiwan 3Department of Atmospheric Science, National Taiwan University,
Taipei, Taiwan
Present at
The European Academy of Paediatrics Congress and Master
Course 2015, 17-20 September 2015, Oslo, Norway
Introduction
• Kawasaki disease (KD)
—An acute and multi-systemic vasculitis
—Predominantly occurs in young children age less than
5 years
—15 to 25% of untreated children may affect coronary
arteries
• The etiology of KD remains unknown!
2
Introduction
• The increase of KD cases from Japan, Hawaii, and
San Diego is associated with a large-scale shift in the
Asia-North Pacific wind pattern (Rodó et al. 2011)
—The etiological agent of KD probably spread by wind
• Air pollution is one of the airborne environmental
factors, the role of air pollutants contribute to KD is
unclear.
3
Aims
• We conducted a time stratified case-crossover study
to assess the effects of air pollutants on the risk of KD
and controlled for meteorological variables.
4
Data source
• Longitudinal Health Insurance Database 2000 (LHID2000)
—A subset data of Taiwan National Health Insurance Research Database (NHIRD)
—1,000,000 individuals
—Followed to the end of 2010
—Outpatient visit, inpatient visit, prescriptions, diagnosis of disease based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)
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Definition of KD
• Children aged less than 5 years old
• With a diagnosis of KD (ICD-9-CM code 446.1) from
January 1, 2000 to December 31, 2010.
—Assigned by pediatricians
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Exposure assessment
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Calculate the country
level average
concentration of air
pollutants
Inverse distance
weighting
(IDW)
CO
NO2
O3
PM10
SO2
Covariates
• 2 meter temperature
• 2 meter dew point temperature
—From European Center for Medium-Range Weather
Forecasts (ECMWF).
• RH ≈ 100 − 5 𝑡 − 𝑡𝑑
—RH is the relative humidity in percent, td and t are the
2 meter dew point temperature and 2 meter
temperature in degrees Celsius, separately
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Study design
9 Calendar month
Direction of time
Arrows pointing up
indicate case periods;
vertical lines indicate
control periods.
Time stratified case crossover study
Results
• A total of 697 KD hospital admissions from
LHID2000 during January 1, 2000 to December 31,
2010.
• The mean age of admissions: 2.54 years (0.11-4.99
years)
• Most were male (56.81%)
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Associations between KD and air
pollution—single pollutant models (1)
11
OR, 95%CI Adjusted OR P for
trend O3 per 28.73 ppb change 1.17 (1.01-1.35) 1.22 (1.03-1.45) 1.17-27.18 ppb 1.00 1.00 0.11 27.18-41.13 ppb 1.27 (0.99-1.63) 1.30 (1.01-1.69) 41.13-55.91 ppb 1.23 (0.95-1.59) 1.29 (0.97-1.70) 55.91-106.52 ppb 1.33 (1.00-1.75) 1.42 (1.03-1.97) NO2 per 13.34 ppb change 1.05 (0.87-1.26) 1.05 (0.87-1.27) 2.64-16.02 ppb 1.00 1.00 0.02 16.02-22.33 ppb 0.99 (0.75-1.30) 0.99 (0.75-1.30) 22.33-29.36 ppb 1.00 (0.72-1.39) 1.00 (0.72-1.39) 29.36-72.02 ppb 1.24 (0.87-1.76) 1.25 (0.88-1.78)
Associations between KD and air
pollution—single pollutant models (2)
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OR, 95%CI Adjusted OR P for
trend CO per 0.34 ppm change 0.99 (0.89-1.11) 1.00 (0.89-1.12) 0.15-0.54 ppm 1.00 1.00 0.06 0.54-0.69 ppm 0.91 (0.70-1.19) 0.91 (0.70-1.19) 0.69-0.88 ppm 1.03 (0.77-1.37) 1.04 (0.77-1.39) 0.88-9.27 ppm 1.12 (0.81-1.54) 1.16 (0.84-1.60) PM10 per 40.60 μg/m3 change 1.10 (0.94-1.28) 1.10 (0.94-1.30) 10.75-34.54 μg/m3 1.00 1.00 0.22 34.54-50.62 μg/m3 1.12 (0.87-1.45) 1.12 (0.86-1.45) 50.62-75.14 μg/m3 1.01 (0.77-1.33) 1.01 (0.75-1.35) 75.14-235.43 μg/m3 1.17 (0.85-1.60) 1.17 (0.83-1.64)
Associations between KD and air
pollution—single pollutant models (3)
OR, 95%CI Adjusted OR P for
trend SO2 per 3.47 ppb change 1.06 (0.92-1.22) 1.06 (0.91-1.22) 0.05-2.40 ppb 1.00 1.00 0.69 2.40-3.92 ppb 1.19 (0.91-1.54) 1.18 (0.90-1.54) 3.92-5.87 ppb 1.09 (0.82-1.45) 1.09 (0.82-1.46) 5.87-25.68 ppb 1.13 (0.83-1.55) 1.13 (0.82-1.57)
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Lag pattern
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Conclusion
• In animal study
—Inhalation of O3 increased vascular dysfunction,
oxidative stress, mitochondrial damage, and
accelerate atherogenesis.
• Children exposure to O3 may increase the risk of KD.
However, further investigation is needed to
understand the plausible biological mechanism.
15
Thank you for your listening
• Acknowledgment —Ministry of Science and Technology of Taiwan under MOST-104-
2922-I-039-016
—China Medical University
—Taiwan Environmental Protection Administration
—Taiwan National Health Research Institutes
• Contact information —Chau-Ren Jung, Ph.D. Student
—Bing-Fang Hwang, Professor
—China Medical University
—Department of Occupational Safety and Health
—Tel/Fax: +886-4-22053366 ext. 2208
—E-Mail: [email protected]; [email protected]
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Exposure assessment
• The daily average of air pollutants ( 24-hour for
CO, NO2, SO2, and PM10; 8-hour (1000-1800
hours) for O3 ) were calculated for subsequent
analyses, at least 75% of the 1 hour values must
be available on that particulate day
• The monitoring data were interpolated to daily
pollutant surfaces using inverse distance
weighting method (IDW)
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Distribution of daily data during
study period
Daily Variable Mean [SD] Min. Max. IQR Air pollutants CO (ppm) 0.75 (0.35) 0.15 9.27 0.34 NO2 (ppb) 23.20 (9.41) 2.64 72.02 13.34 O3 (ppb) 42.75 (19.36) 1.17 106.52 28.73 PM10 (μg/m3) 57.39 (29.88) 10.75 235.43 40.60 SO2 (ppb) 4.43 (2.80) 0.05 25.68 3.47 Temperature (℃) 21.86 (5.03) 5.54 30.69 7.83 Humidity (%) 81.85 (8.67) 51.15 98.98 12.50
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Exposure assessment
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CO
NO2
O3
PM10
SO2
Air pollutants monitoring data
from Taiwan EPA
Correlation between air pollutants and
meteorological variables
CO NO2 O3 PM10 SO2 Temperature
CO 1.00
NO2 0.77** 1.00
O3 0.14** 0.23** 1.00
PM10 0.48** 0.63** 0.57** 1.00
SO2 0.40** 0.55** 0.27** 0.54** 1.00
Temperature -0.23** -0.43** 0.05* -0.30** 0.02 1.00
Humidity -0.01 -0.17** -0.51** -0.43** -0.29** -0.05*
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Associations between KD and ozone
from multi-pollutant models
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