Lifetime-ever pneumonia among pre-school children across China - Associations with pre-natal and post-natal early life environmental factors

Dan Norbäck; Chan Lu; Yinping Zhang; Baizhan Li; Zhuohui Zhao; Chen Huang; Xin Zhang; Hua Qian; Yuexia Sun; Jan Sundell; Juan Wang; Wei Liu; Qihong Deng

doi:10.1016/j.envres.2018.08.003

Lifetime-ever pneumonia among pre-school children across China - Associations with pre-natal and post-natal early life environmental factors

Environ Res. 2018 Nov:167:418-427. doi: 10.1016/j.envres.2018.08.003. Epub 2018 Aug 6.

Authors

Dan Norbäck¹, Chan Lu², Yinping Zhang³, Baizhan Li⁴, Zhuohui Zhao⁵, Chen Huang⁶, Xin Zhang⁷, Hua Qian⁸, Yuexia Sun⁹, Jan Sundell⁹, Juan Wang¹⁰, Wei Liu³, Qihong Deng¹¹

Affiliations

¹ School of Energy Science and Engineering, Central South University, Changsha, Hunan, China; Department of Medical Sciences, Uppsala University, Uppsala, Sweden. Electronic address: dan.norback@medsci.uu.se.
² School of Energy Science and Engineering, Central South University, Changsha, Hunan, China; XingYa School of Public Health, Central South University, Changsha, Hunan, China.
³ School of Architecture, Tsinghua University, Beijing, China.
⁴ Key Laboratory of Three Gorges Reservoir Region's Eco-Environment, Chongqing University, Chongqing, China.
⁵ Department of Environmental Health, Fudan University, Shanghai, China.
⁶ Department of Building Environment and Energy Engineering, School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China.
⁷ Research Center for Environmental Science and Engineering, Shanxi University, Taiyuan, China.
⁸ School of Energy & Environment, Southeast University, Nanjing, China.
⁹ School of Environmental Science and Engineering, Tianjin University, Tianjin, China.
¹⁰ Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Key Laboratory of Three Gorges Reservoir Region's Eco-Environment, Chongqing University, Chongqing, China.
¹¹ School of Energy Science and Engineering, Central South University, Changsha, Hunan, China; XingYa School of Public Health, Central South University, Changsha, Hunan, China. Electronic address: qhdeng@csu.edu.cn.

PMID: 30121466
DOI: 10.1016/j.envres.2018.08.003

Abstract

Background: Biomass burning is associated with childhood pneumonia but few studies exist on other indoor factors.

Aim: To study pneumonia in relation to pre-natal and post-natal exposure among children across China.

Methods: Children (3-6 y) (n = 39,782) from randomized day care centres in seven cities in China. Information on pneumonia and pre-natal and post-natal exposure to home environment factors were assessed by a parental questionnaire. Life-time outdoor temperature and GDP per capita were assessed on city level. Associations were calculated by multilevel logistic regression adjusting for fourteen co-variates.

Results: Totally 32.0% had ever had pneumonia diagnosed by a physician. Children of farmer mothers (OR = 0.65), with breastfeeding (OR = 0.91) and living in rural (OR = 0.85) or suburban (OR = 0.90) areas had less pneumonia. Buying new furniture one year before conception (OR = 1.11) and after first year of life (OR = 1.10) increased the risk. Redecoration one year before conception (OR = 1.20), during pregnancy (OR = 1.18) and after first year of life (OR = 1.17) increased pneumonia risk. Children with mould (OR = 1.17), window pane condensation (WPC) (OR = 1.20) and mould odour (OR = 1.15) at home at birth only had a higher risk of pneumonia. Similar associations were seen for dampness and mould in the current home. Children in the oldest and newest homes had less pneumonia. Cockroaches (OR = 1.08), mosquitos or flies in the current home (OR = 1.18), an exhaust fan in the bathroom (OR = 1.10) and higher economic development level, measured as GDP per capita on city level (OR 1.11 per 10,000 RMB/year) were associated with childhood pneumonia.

Conclusions: Perinatal and postnatal exposure to mould, mould odour and window pane condensation at home can be early life risk factors for childhood pneumonia in China. Moreover, pre-natal and post-natal exposure to chemical emissions from new furniture and renovation could increase the risk of childhood pneumonia. Breastfeeding, farm exposure, and living in rural or suburban areas could be protective.

Keywords: Farm exposure; Mould; Pneumonia; Renovation; Window pane condensation.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Animals
Child
Child, Preschool
China / epidemiology
Cities
Environmental Exposure*
Female
Fungi
Humans
Insecta
Pneumonia / epidemiology*
Pregnancy
Risk Factors