Original Articles: Mechanisms of Allergic and Immune Diseases
Traffic and outdoor air pollution levels near residences and poorly controlled asthma in adults

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Background

Air pollution may exacerbate asthma.

Objective

To investigate associations between traffic and outdoor air pollution levels near residences and poorly controlled asthma among adults diagnosed as having asthma in Los Angeles and San Diego counties, California.

Methods

We estimated traffic density within 500 ft of 2001 California Health Interview Survey respondents’ reported residential cross-street intersections. Additionally, we assigned annual average concentrations of ozone, nitrogen dioxide, particulate matter 2.5 and 10 micrometers or less in diameter, and carbon monoxide measured at government monitoring stations within a 5-mile radius of the reported residential cross-street intersections.

Results

We observed a 2-fold increase in poorly controlled asthma (odds ratio [OR], 2.11; 95% confidence interval [CI], 1.38-3.23) among asthmatic adults in the highest quintile of traffic density after adjusting for age, sex, race, and poverty. Similar increases were seen for nonelderly adults, men, and women, although associations seemed strongest in elderly adults (OR, 3.00; 95% CI, 1.13-7.91). Ozone exposures were associated with poorly controlled asthma among elderly adults (OR, 1.70; 95% CI, 0.91-3.18 per 1 pphm) and men (OR, 1.76; 95% CI, 1.05-2.94 per 1 pphm), whereas particulate matter 10 micrometers or less seemed to affect primarily women (OR, 2.06; 95% CI, 1.17-3.61), even at levels below the national air quality standard.

Conclusions

Heavy traffic and high air pollution levels near residences are associated with poorly controlled asthma.

Section snippets

INTRODUCTION

Despite major advances in the development of anti-inflammatory medications in the last 2 decades, many Americans have poorly controlled asthma. In California, nearly 25% of adults diagnosed as having asthma experienced asthma symptoms every day or week, 7.2% of adults reported at least 1 emergency department (ED) visit for asthma, and 2.2% reported they were hospitalized for asthma in 2000.1 Poorly controlled asthma, either chronic or acute, contributes disproportionately to the overall costs

Study Population

This study linked population-based survey data obtained from respondents of CHIS 2001 with traffic count and ambient air monitoring data. Eligible respondents were individuals from whom health data were collected between November 2000 and September 2001 as part of CHIS 2001. The University of California, Los Angeles, Institutional Review Board approved this study as exempt from review. A total of 55,428 California households were surveyed in English, Spanish, Chinese, Vietnamese, Korean, or

RESULTS

The study population was composed of more women (58.1%) and nonelderly adults (Table 1). Among nonelderly adults with asthma, 18.6% were current smokers. The overall prevalence of poorly controlled asthma was 26.3% for all asthmatic adults 18 years and older. The prevalence of poorly controlled asthma increased with age and reached 38.1% among elderly adults (≥65 years). Women reported a slightly higher prevalence of poorly controlled asthma than men (27.9% vs 24.1%). Adults with a family

DISCUSSION

Our results add to the growing body of epidemiologic evidence that suggests that adults with asthma are adversely affected by long-term exposure to air pollution. Because of the lack of an asthma disease registry in the United States, population-based data such as those from the CHIS are valuable not only for understanding the prevalence of poorly controlled asthma in various regions or subpopulations, but also for performing association studies such as the one presented herein through linking

ACKNOWLEDGMENTS

The authors thank Yan Xiong, MS, and others for statistical and programming support and Sheila Nathan, MPH, and Marlena Kuruvilla, MSW/MPH, for research assistance.

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    This study was supported by the Agency for Toxic Substances and Disease Registry (ATSDR: U61/ATU972304). Its contents do not necessarily represent the official views of ATSDR.

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