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Tischer, C.* ; Dadvand, P.* ; Basagana, X.* ; Fuertes, E.* ; Bergström, A.* ; Gruzieva, O.* ; Melén, E.* ; Berdel, D.* ; Heinrich, J. ; Koletzko, S.* ; Markevych, I. ; Standl, M. ; Sugiri, D.* ; Cirugeda, L.* ; Estarlich, M.* ; Fernández-Somoano, A.* ; Ferrero, A.* ; Ibarlueza, J.* ; Lertxundi, A.* ; Tardón, A.* ; Sunyer, J.* ; Antò, J.M.*

Urban upbringing and childhood respiratory and allergic conditions: A multi-country holistic study.

Environ. Res. 161, 276-283 (2018)

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OBJECTIVE: We integratively assessed the effect of different indoor and outdoor environmental exposures early in life on respiratory and allergic health conditions among children from (sub-) urban areas. METHODS: This study included children participating in four ongoing European birth cohorts located in three different geographical regions: INMA (Spain), LISAplus (Germany), GINIplus (Germany) and BAMSE (Sweden). Wheezing, bronchitis, asthma and allergic rhinitis throughout childhood were assessed using parental-completed questionnaires. We designed "environmental scores" corresponding to different indoor, green- and grey-related exposures (main analysis, a-priori-approach). Cohort-specific associations between these environmental scores and the respiratory health outcomes were assessed using random-effects meta-analyses. In addition, a factor analysis was performed based on the same exposure information used to develop the environmental scores (confirmatory analysis, data-driven-approach). RESULTS: A higher early exposure to the indoor environmental score increased the risk for wheezing and bronchitis within the first year of life (combined adjusted odds ratio: 1.20 [95% confidence interval: 1.13-1.27] and 1.28 [1.18-1.39], respectively). In contrast, there was an inverse association with allergic rhinitis between 6 and 8 years (0.85 [0.79-0.92]). There were no statistically significant associations for the outdoor related environmental scores in relation to any of the health outcomes tested. The factor analysis conducted confirmed these trends. CONCLUSION: Although a higher exposure to indoor related exposure through occupants was associated with an increased risk for wheezing and bronchitis within the 1st year, it might serve as a preventive mechanism against later childhood allergic respiratory outcomes in urbanized environments through enhanced shared contact with microbial agents.

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