Traffic-Related Air Pollution and Autism Spectrum Disorder: A Population-Based Nested Case-Control Study in Israel

Am J Epidemiol. 2018 Apr 1;187(4):717-725. doi: 10.1093/aje/kwx294.


Accumulating evidence suggests that perinatal air pollutant exposures are associated with increased risk of autism spectrum disorder (ASD), but evidence for traffic pollutants outside the United States is inconclusive. We assessed the association between nitrogen dioxide, a traffic pollution tracer, and risk of ASD. We conducted a nested case-control study among the entire population of children born during 2005-2009 in the central coastal area of Israel. Cases were identified through the National Insurance Institute of Israel (n = 2,098). Controls were a 20% random sample of the remaining children (n = 54,191). Exposure was based on an optimized dispersion model. We estimated adjusted odds ratios and 95% confidence intervals using logistic regression and a distributed-lag model. In models mutually adjusted for the 2 periods, the odds ratio per 5.85-parts per billion (ppb) increment of nitrogen dioxide exposure during pregnancy (median, 16.8 ppb; range, 7.5-31.2 ppb) was 0.77 (95% confidence interval: 0.59, 1.00), and the odds ratio for exposure during the 9 months after birth was 1.40 (95% confidence interval: 1.09, 1.80). A distributed-lag model revealed reduced risk around week 13 of pregnancy and elevated risk around week 26 after birth. These findings suggest that postnatal exposure to nitrogen dioxide in Israel is associated with increased odds of ASD, and prenatal exposure with lower odds. The latter may relate to selection effects.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Autism Spectrum Disorder / epidemiology*
  • Case-Control Studies
  • Environmental Exposure / adverse effects
  • Environmental Exposure / analysis*
  • Female
  • Gestational Age
  • Humans
  • Israel / epidemiology
  • Logistic Models
  • Male
  • Nitrogen Dioxide / analysis*
  • Pregnancy
  • Prenatal Exposure Delayed Effects / epidemiology*
  • Risk Factors
  • Socioeconomic Factors
  • Traffic-Related Pollution / adverse effects
  • Traffic-Related Pollution / analysis*


  • Nitrogen Dioxide