Benefits of influenza vaccination on the associations between ambient air pollution and allergic respiratory diseases in children and adolescents: New insights from the Seven Northeastern Cities study in China

Kangkang Liu; Shanshan Li; Zhengmin Min Qian; Shyamali C Dharmage; Michael S Bloom; Joachim Heinrich; Bin Jalaludin; Iana Markevych; Lidia Morawska; Luke D Knibbs; Leslie Hinyard; Hong Xian; Shan Liu; Shao Lin; Ari Leskinen; Mika Komppula; Pasi Jalava; Marjut Roponen; Li-Wen Hu; Xiao-Wen Zeng; Wenbiao Hu; Gongbo Chen; Bo-Yi Yang; Yuming Guo; Guang-Hui Dong

doi:10.1016/j.envpol.2019.113434

Benefits of influenza vaccination on the associations between ambient air pollution and allergic respiratory diseases in children and adolescents: New insights from the Seven Northeastern Cities study in China

Environ Pollut. 2020 Jan:256:113434. doi: 10.1016/j.envpol.2019.113434. Epub 2019 Oct 19.

Authors

Kangkang Liu¹, Shanshan Li², Zhengmin Min Qian³, Shyamali C Dharmage⁴, Michael S Bloom⁵, Joachim Heinrich⁶, Bin Jalaludin⁷, Iana Markevych⁸, Lidia Morawska⁹, Luke D Knibbs¹⁰, Leslie Hinyard¹¹, Hong Xian³, Shan Liu¹², Shao Lin¹³, Ari Leskinen¹⁴, Mika Komppula¹⁵, Pasi Jalava¹⁶, Marjut Roponen¹⁶, Li-Wen Hu¹, Xiao-Wen Zeng¹, Wenbiao Hu¹⁷, Gongbo Chen¹⁸, Bo-Yi Yang¹, Yuming Guo², Guang-Hui Dong¹⁹

Affiliations

¹ Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
² Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.
³ Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, Saint Louis, 63104, USA.
⁴ Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, 3052, Australia.
⁵ Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China; Department of Environmental Health Sciences and Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY, 12144, USA.
⁶ Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig-Maximilian-University, Munich, 80336, Germany.
⁷ School of Public Health and Community Medicine, The University of New South Wales, Kensington, NSW, 2052, Australia.
⁸ Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstädter Landstraße 1, Neuherberg, 85764, Germany; Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, Munich, Ludwig-Maximilians-University of Munich, Munich, 80336, Germany; Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig-Maximilian-University, Munich, 80336, Germany.
⁹ International Laboratory for Air Quality & Health (ILAQH), Science and Engineering Faculty, Institute of Health Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, 4059, Australia.
¹⁰ School of Public Health, The University of Queensland, Herston, Queensland, 4006, Australia.
¹¹ Center for Health Outcomes Research, Saint Louis University, Saint Louis, 63104, USA.
¹² NHC Key Laboratory of Food Safety Risk Assessment, China National Center for Food Safety Risk Assessment, Beijing, 100021, China.
¹³ Department of Environmental Health Sciences and Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY, 12144, USA.
¹⁴ Finnish Meteorological Institute, Kuopio, 70211, Finland; Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, 70211, Finland.
¹⁵ Finnish Meteorological Institute, Kuopio, 70211, Finland.
¹⁶ Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, 70211, Finland.
¹⁷ School of Public Health and Social Work, Queensland University of Technology, Brisbane, 4059, Australia.
¹⁸ Department of Global Health, School of Health Sciences, Wuhan University, Wuhan, 430000, China.
¹⁹ Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China. Electronic address: donggh5@mail.sysu.edu.cn.

PMID: 31672350
DOI: 10.1016/j.envpol.2019.113434

Abstract

Background: Little information exists on interaction effects between air pollution and influenza vaccination on allergic respiratory diseases. We conducted a large population-based study to evaluate the interaction effects between influenza vaccination and long-term exposure to ambient air pollution on allergic respiratory diseases in children and adolescents.

Methods: A cross-sectional study was investigated during 2012-2013 in 94 schools from Seven Northeastern Cities (SNEC) in China. Questionnaires surveys were obtained from 56 137 children and adolescents aged 2-17 years. Influenza vaccination was defined as receipt of the influenza vaccine. We estimated air pollutants exposure [nitrogen dioxide (NO₂) and particulate matter with aerodynamic diameters ≤1 μm (PM₁), ≤2.5 μm (PM_2.5) and ≤10 μm (PM₁₀)] using machine learning methods. We employed two-level generalized linear mix effects model to examine interactive effects between influenza vaccination and air pollution exposure on allergic respiratory diseases (asthma, asthma-related symptoms and allergic rhinitis), after controlling for important covariates.

Results: We found statistically significant interactions between influenza vaccination and air pollutants on allergic respiratory diseases and related symptoms (doctor-diagnosed asthma, current wheeze, wheeze, persistent phlegm and allergic rhinitis). The adjusted ORs for doctor-diagnosed asthma, current wheeze and allergic rhinitis among the unvaccinated group per interquartile range (IQR) increase in PM₁ and PM_2.5 were significantly higher than the corresponding ORs among the vaccinated group [For PM₁, doctor-diagnosed asthma: OR: 1.89 (95%CI: 1.57-2.27) vs 1.65 (95%CI: 1.36-2.00); current wheeze: OR: 1.50 (95%CI: 1.22-1.85) vs 1.10 (95%CI: 0.89-1.37); allergic rhinitis: OR: 1.38 (95%CI: 1.15-1.66) vs 1.21 (95%CI: 1.00-1.46). For PM_2.5, doctor-diagnosed asthma: OR: 1.81 (95%CI: 1.52-2.14) vs 1.57 (95%CI: 1.32-1.88); current wheeze: OR: 1.46 (95%CI: 1.21-1.76) vs 1.11 (95%CI: 0.91-1.35); allergic rhinitis: OR: 1.35 (95%CI: 1.14-1.60) vs 1.19 (95%CI: 1.00-1.42)]. The similar patterns were observed for wheeze and persistent phlegm. The corresponding p values for interactions were less than 0.05, respectively. We assessed the risks of PM₁-related and PM_2.5-related current wheeze were decreased by 26.67% (95%CI: 1.04%-45.66%) and 23.97% (95%CI: 0.21%-42.08%) respectively, which was attributable to influenza vaccination (both p for efficiency <0.05).

Conclusions: Influenza vaccination may play an important role in mitigating the detrimental effects of long-term exposure to ambient air pollution on childhood allergic respiratory diseases. Policy targeted at increasing influenza vaccination may yield co-benefits in terms of reduced allergic respiratory diseases.

Keywords: Air pollutants; Asthma; Children and adolescents; Influenza vaccination; Interaction effects.

MeSH terms

Adolescent
Air Pollutants / analysis
Air Pollution / analysis
Air Pollution / statistics & numerical data*
Asthma / epidemiology
Child
Child, Preschool
China
Cities
Cross-Sectional Studies
Environmental Exposure / statistics & numerical data*
Female
Humans
Hypersensitivity / epidemiology
Influenza, Human
Logistic Models
Male
Nitrogen Dioxide
Particulate Matter / analysis
Respiration Disorders
Respiratory Sounds
Respiratory Tract Diseases / epidemiology*
Risk Factors
Schools
Surveys and Questionnaires
Vaccination

Substances

Air Pollutants
Particulate Matter
Nitrogen Dioxide