Early-Life Exposure to Outdoor Air Pollution and Respiratory Health, Ear Infections, and Eczema in Infants from the INMA Study

Inmaculada Aguilera,^1,2 Marie Pedersen,^1,2,3 Raquel Garcia-Esteban,^1,2 Ferran Ballester,^2,4,5 Mikel Basterrechea,^2,6,7 Ana Esplugues,^2,4,5 Ana Fernández-Somoano,^2,8 Aitana Lertxundi,^7,9 Adonina Tardón,^2,9 and Jordi Sunyer^1,2,10,11

¹Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; ²Consortium for Research in Epidemiology and Public Health (CIBERESP), Spain; ³National Institute of Health and Medical Research (INSERM), U823, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, Grenoble, France; ⁴Centre of Public Health Research (CSISP), Valencia, Spain; ⁵School of Nursing, University of Valencia, Valencia, Spain; ⁶Public Health Division of Gipuzkoa, Basque Country Government, Gipuzkoa, Spain; ⁷BioDonostia Health Research Institute, Donostia, Spain; ⁸University of Oviedo, Oviedo, Spain; ⁹Department of Public Health and Preventive Medicine, University of Basque Country, Bilbao, Spain; ¹⁰Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; ¹¹Pompeu Fabra University, Department of Experimental and Health Sciences, Barcelona, Spain

Abstract

Background: Prenatal and early-life periods may be critical windows for harmful effects of air pollution on infant health.

Objectives: We studied the association of air pollution exposure during pregnancy and the first year of life with respiratory illnesses, ear infections, and eczema during the first 12–18 months of age in a Spanish birth cohort of 2,199 infants.

Methods: We obtained parentally reported information on doctor-diagnosed lower respiratory tract infections (LRTI) and parental reports of wheezing, eczema, and ear infections. We estimated individual exposures to nitrogen dioxide (NO₂) and benzene with temporally adjusted land use regression models. We used log-binomial regression models and a combined random-effects meta-analysis to estimate the effects of air pollution exposure on health outcomes across the four study locations.

Results: A 10-µg/m³ increase in average NO₂ during pregnancy was associated with LRTI [relative risk (RR) = 1.05; 95% CI: 0.98, 1.12] and ear infections (RR = 1.18; 95% CI: 0.98, 1.41). The RRs for an interquartile range (IQR) increase in NO₂ were 1.08 (95% CI: 0.97, 1.21) for LRTI and 1.31 (95% CI: 0.97, 1.76) for ear infections. Compared with NO₂, the association for an IQR increase in average benzene exposure was similar for LRTI (RR = 1.06; 95% CI: 0.94, 1.19) and slightly lower for ear infections (RR = 1.17; 95% CI: 0.93, 1.46). Associations were slightly stronger among infants whose mothers spent more time at home during pregnancy. Air pollution exposure during the first year was highly correlated with prenatal exposure, so we were unable to discern the relative importance of each exposure period.

Conclusions: Our findings support the hypothesis that early-life exposure to ambient air pollution may increase the risk of upper and lower respiratory tract infections in infants.

Key words: air pollution, children’s health, ear infections, eczema, in utero exposure, respiratory infections.

Environ Health Perspect 121:387–392 (2013). http://dx.doi.org/10.1289/ehp.1205281 [Online 5 December 2012]

Address correspondence to I. Aguilera, Centre for Research in Environmental Epidemiology, Doctor Aiguader 88, 08003 Barcelona, Spain. Telephone: 34 932147300. E-mail: iaguilera@creal.cat

Supplemental Material is available online (http://dx.doi.org/10.1289/ehp.1205281).

We thank all the participants for their generous collaboration. A full roster of the INMA project investigators can be found at http://www.proyectoinma.org/presentacion-inma/listado-investigadores/en_listado-investigadores.html.

This study was funded by grants from Spanish Ministry of Health–Instituto de Salud Carlos III (Red INMA G03/176, CB06/02/0041, FIS-PI041436, FIS- PI081151, FIS-PI042018, FIS-PI09/02311, FIS-PI06/0867, FIS-PS09/00090, FIS-FEDER 03/1615, 04/1509, 04/1112, 04/1931, 05/1079, 05/1052, 06/1213, 07/0314, and 09/02647), Generalitat de Catalunya-CIRIT (Consejo Interdepartamental de Investigación e Innovación Tecnológica) (1999SGR 00241), Conselleria de Sanitat Generalitat Valenciana, Universidad de Oviedo, Obra social Cajastur, Department of Health of the Basque Government (2005111093 and 2009111069), Provincial Government of Gipuzkoa (DFG06/004 and DFG08/001), and Fundación Roger Torné. M.P. holds a Juan de la Cierva post-doctoral fellowship awarded from the Spanish Ministry of Science and Innovation (JCI-2011-09479).

The authors declare they have no actual or potential competing financial interests.

Received 29 March 2012; Accepted 4 December 2012; Online 5 December 2012.