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Modification of Caesarean Section on the Associations between Air Pollution and Asthma in Seven Chinese Cities

24 Pages Posted: 29 Oct 2019

See all articles by Hongyao Yu

Hongyao Yu

Sun Yat-Sen University (SYSU) - Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment

Yang Zhou

Sun Yat-Sen University (SYSU) - Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment

Li-Wen Hu

Sun Yat-Sen University (SYSU) - Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment

Yuming Guo

Monash University - School of Public Health and Preventive Medicine

Zhengmin Qian

Saint Louis University

Jia Sun

Saint Louis University

Stephen Edward McMillin

Saint Louis University

Michael S. Bloom

Sun Yat-Sen University (SYSU) - Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment; University at Albany (SUNY)

Joachim Heinrich

Ludwig Maximilian University of Munich (LMU)

Iana Markevych

Ludwig Maximilian University of Munich (LMU); German Research Center for Environmental Health - Helmholtz Center Munich

Lidia Morawska

Queensland University of Technology

Shyamali C. Dharmage

University of Melbourne

Bin Jalaludin

Centre for Air Quality and Health Research and Evaluation; University of New South Wales (UNSW)

Luke D. Knibbs

University of Queensland - School of Public Health

Shao Lin

SUNY University at Albany

Pasi Jalava

University of Eastern Finland

Marjut Roponen

University of Eastern Finland

Ari Leskinen

Government of the Republic of Finland - Finnish Meteorological Institute; University of Eastern Finland - Department of Applied Physics

Mika Komppula

Government of the Republic of Finland - Finnish Meteorological Institute

Steve Hung Lam Yim

The Chinese University of Hong Kong (CUHK) - Department of Geography and Resource Management; The Chinese University of Hong Kong (CUHK) - Institute of Environment, Energy and Sustainability; The Chinese University of Hong Kong (CUHK) - Stanley Ho Big Data Decision Analytics Research Centre

Meng Gao

Hong Kong Baptist University (HKBU)

Bo-Yi Yang

Sun Yat-Sen University (SYSU) - Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment

Ru-Qing Liu

Sun Yat-Sen University (SYSU) - Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment

Xiao-Wen Zeng

Sun Yat-Sen University (SYSU) - Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment

Yunjiang Yu

South China Institute of Environmental Sciences

Guang-Hui Dong

Sun Yat-Sen University (SYSU) - Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment

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Abstract

Background: It is unknown whether giving birth via caesarean section (c-section) is a modifier for the association between air pollution and asthma.

Methods: From 2012 to 2013, 59,754 children between the ages of 2 and 17 were randomly selected from 94 middle schools, elementary schools and kindergartens in seven Chinese cities for a cross-sectional study. The children's parents or guardians completed questionnaires, from which data on asthma as well as asthma-related symptoms were obtained. Participants' exposure to particles with an aerodynamic diameter ≤1·0μm (PM1), ≤2·5μm (PM2·5), and ≤10μm (PM10) and exposure to nitrogen dioxide (NO2) were estimated using random forest models. We used two-level logistic regressions and added an interaction term between mode of delivery and ambient air pollution into the model to estimate effect modification from c-sections after appropriate adjustments for potential confounding variables.

Findings: Among children delivered by c-section, the adjusted ORs for asthma and its symptoms per 10 μg/m3 air pollutant increase (1·14 95% CI: 1·09-1·19 to 2·10 95% CI: 1·88-2·34) were significantly higher than those of children delivered vaginally (1·04 95% CI: 0·97-1·13 to 1·38 95%CI: 1·23-1·55). The interactions between c-sections and ambient air pollution were statistically significant for all studied respiratory disorders, except current wheeze.

Interpretation: Delivery via c-section appears to increase the risks of air pollution on asthma and its symptoms in our study population of Chinese children.

Funding Statement:This work was supported by the National Natural Science Foundation of China (81872582, 91543208, 81872583, 81673128, and 81703179), the National Key Research and Development Program of China (2018YFE0106900), the Guangdong Provincial Natural Science Foundation Team Project (2018B030312005), the Guangdong Province Natural Science Foundation (2017A050501062, and 2018B05052007), and the Fundamental Research Funds for the Central Universities (19ykjc01).

Declaration of Interests: The authors declare no competing interest.

Ethics Approval Statement: The study was designed and conducted in accordance with the World Medical Association’s Declaration of Helsinki Ethical Principles for Medical Research Involving Human Subjects. The Human Studies Committee of Sun Yat-sen University, Guangzhou, China approved this study. After approval was obtained from each school’s principal, parents or guardians of children were invited to take part in information sessions where consent form was signed and questionnaires were completed

Keywords: Caesarean section; air pollution; Asthma; Asthma-related symptom; Effect modification

Suggested Citation

Yu, Hongyao and Zhou, Yang and Hu, Li-Wen and Guo, Yuming and Qian, Zhengmin and Sun, Jia and McMillin, Stephen Edward and Bloom, Michael S. and Heinrich, Joachim and Markevych, Iana and Morawska, Lidia and Dharmage, Shyamali C. and Jalaludin, Bin and Knibbs, Luke D. and Lin, Shao and Jalava, Pasi and Roponen, Marjut and Leskinen, Ari and Komppula, Mika and Yim, Steve Hung Lam and Gao, Meng and Yang, Bo-Yi and Liu, Ru-Qing and Zeng, Xiao-Wen and Yu, Yunjiang and Dong, Guang-Hui, Modification of Caesarean Section on the Associations between Air Pollution and Asthma in Seven Chinese Cities (10/21/2019 03:15:28). Available at SSRN: https://ssrn.com/abstract=3473299 or http://dx.doi.org/10.2139/ssrn.3473299

Hongyao Yu

Sun Yat-Sen University (SYSU) - Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment

China

Yang Zhou

Sun Yat-Sen University (SYSU) - Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment

China

Li-Wen Hu

Sun Yat-Sen University (SYSU) - Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment

China

Yuming Guo

Monash University - School of Public Health and Preventive Medicine

Australia

Zhengmin Qian

Saint Louis University

220 North Grand Boulevard
St. Louis, MO 63103
United States

Jia Sun

Saint Louis University

220 North Grand Boulevard
St. Louis, MO 63103
United States

Stephen Edward McMillin

Saint Louis University

220 North Grand Boulevard
St. Louis, MO 63103
United States

Michael S. Bloom

Sun Yat-Sen University (SYSU) - Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment

China

University at Albany (SUNY)

1400 Washington Ave
Albany, NY 12222
United States

Joachim Heinrich

Ludwig Maximilian University of Munich (LMU)

Geschwister-Scholl-Platz 1
Munich, DE Bavaria 80539
Germany

Iana Markevych

Ludwig Maximilian University of Munich (LMU)

Geschwister-Scholl-Platz 1
Munich, DE Bavaria 80539
Germany

German Research Center for Environmental Health - Helmholtz Center Munich

Institute for Bioinformatics and Systems Biology
Ingolstaedter Landstrasse 1
Neuherberg, 85764
Germany

Lidia Morawska

Queensland University of Technology

2 George Street
Brisbane, Queensland 4000
Australia

Shyamali C. Dharmage

University of Melbourne

185 Pelham Street
Carlton, Victoria 3053
Australia

Bin Jalaludin

Centre for Air Quality and Health Research and Evaluation

Australia

University of New South Wales (UNSW)

Kensington
High St
Sydney, NSW 2052
Australia

Luke D. Knibbs

University of Queensland - School of Public Health

St Lucia
Brisbane
Australia

Shao Lin

SUNY University at Albany

1400 Washington Avenue
Building, Room 109
Albany, NY 12222
United States

Pasi Jalava

University of Eastern Finland

PO Box 111
Joensuu, 80100
Finland

Marjut Roponen

University of Eastern Finland

PO Box 111
Joensuu, 80100
Finland

Ari Leskinen

Government of the Republic of Finland - Finnish Meteorological Institute

P.O.Box 503
FIN-00101 Helsinki
Finland

University of Eastern Finland - Department of Applied Physics

PO Box 111
Joensuu, 80100
Finland

Mika Komppula

Government of the Republic of Finland - Finnish Meteorological Institute

P.O.Box 503
FIN-00101 Helsinki
Finland

Steve Hung Lam Yim

The Chinese University of Hong Kong (CUHK) - Department of Geography and Resource Management ( email )

Hong Kong
China

The Chinese University of Hong Kong (CUHK) - Institute of Environment, Energy and Sustainability ( email )

Shatin, N.T., Hong Kong
China

The Chinese University of Hong Kong (CUHK) - Stanley Ho Big Data Decision Analytics Research Centre ( email )

Shatin, N.T., Hong Kong
China

Meng Gao

Hong Kong Baptist University (HKBU)

Department of Economics
Kowloon, Hong Kong
Hong Kong

Bo-Yi Yang

Sun Yat-Sen University (SYSU) - Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment

China

Ru-Qing Liu

Sun Yat-Sen University (SYSU) - Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment

China

Xiao-Wen Zeng

Sun Yat-Sen University (SYSU) - Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment

China

Yunjiang Yu

South China Institute of Environmental Sciences ( email )

Guangzhou
China

Guang-Hui Dong (Contact Author)

Sun Yat-Sen University (SYSU) - Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment ( email )

China

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