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Urban Air Pollution and Acute Otitis Media in a Population-Based Birth Cohort

MacIntyre, Elaina*; Karr, Catherine; Koehoorn, Mieke*; Demers, Paul*; Tamburic, Lillian*; Lencar, Cornel*; Brauer, Michael*

doi: 10.1097/01.ede.0000362940.54611.54
Abstracts: ISEE 21st Annual Conference, Dublin, Ireland, August 25–29, 2009: Poster Presentations

*University of British Columbia, Vancouver, BC, Canada; and †University of Washington, Seattle, WA, United States.

Abstracts published in Epidemiology have been reviewed by the organizations of Epidemiology. Affliate Societies at whose meetings the abstracts have been accepted for presentation. These abstracts have not undergone review by the Editorial Board of Epidemiology.


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Background and Objective:

Middle ear infection is the main reason children under five years receive antibiotics and a leading reason for physician visits. Recent European studies have identified an association between urban air pollution and these infections. We present findings from the first North American study to investigate the role of traffic-related air pollution and wood burning as preventable risk factors for middle ear infection.

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Middle ear infection was identified during the first two years of life using ICD9 coding of outpatient physician visits linked with antibiotic prescription data for all children born in southwestern British Columbia during 1999–2000. Exposure to traffic-related air pollution (NO, NO2, PM2.5) and wood burning was assessed using land-use regression models derived from detailed monitoring and geographic variables. Potential confounding variables were collected from the Perinatal Database Registry (older siblings, maternal smoking, maternal age, breastfeeding, birth weight, gestational age), hospitalizations (First Nations status), Vital Statistics (gender, birth season) and the 2001 Census (neighborhood income, female education, rural residence). Generalized estimating equations were used to model the impact of air pollution, modeled at the home address, during a 2-month window prior to middle ear infection.

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Full follow-up and risk factor information was available for 39,827 children. Adjusted risk ratios and 95% confidence intervals for an inter-quartile range increase in NO and NO2 were 1.20 (1.18–1.22) and 1.19 (1.17–1.21), respectively. Results for PM2.5 were not significant. The adjusted risk ratio for wood burning prior to infection was 1.58 (1.54–1.62).

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The association between air pollution and middle ear infection suggests that pollution abatement strategies could successfully reduce the impact of this common and costly childhood disease.

© 2009 Lippincott Williams & Wilkins, Inc.