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      Residential Ambient Traffic in Relation to Childhood Pneumonia among Urban Children in Shandong, China: A Cross-Sectional Study

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          Pneumonia is a leading cause of childhood death. Few studies have investigated associations between residential ambient environmental exposures and pneumonia. In January–April 2015, we conducted a cross-sectional study in Shandong Province (China) and collected 9597 (response rate: 78.7%) parent-reported questionnaires for 3–6-year-old children from 69 urban kindergartens. We then selected 5640 children who had never changed residence since birth and examined associations between residential ambient traffic-related facilities and childhood pneumonia considering residential characteristics. Prevalence of doctor-diagnosed pneumonia during lifetime-ever was 25.9%. In the multivariate logistic regression analyses, residence close to a main traffic road (adjusted odds ratio, 95% confidence interval: 1.23, 1.08–1.40) and automobile 4S shop (1.76, 1.16–2.67) within 200 m, residence close to a filling station within 100 m (1.71, 1.10–2.65; reference: >200 m), as well as having a ground car park in the residential community (1.24, 1.08–1.42) were significantly associated with childhood pneumonia. The cumulative numbers of these traffic-related facilities had a positive dose-response relationship with the increased odds of childhood pneumonia. These associations and dose-response relationships were stronger among boys and among children with worse bedroom ventilation status during the night. Associations of residence close to the main traffic road and ground car parks in the residential community with childhood pneumonia were stronger among children living in the 1st–3rd floors than those living on higher floors. Similar results were found in the two-level (kindergarten-child) logistic regression analyses. Our findings indicate that living near traffic-related facilities is likely a risk factor for childhood pneumonia among urban children. The child’s sex, bedroom floor level, and bedroom ventilation could modify associations of ambient traffic-related facilities with childhood pneumonia.

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          Summary Diarrhoea and pneumonia are the leading infectious causes of childhood morbidity and mortality. We comprehensively reviewed the epidemiology of childhood diarrhoea and pneumonia in 2010–11 to inform the planning of integrated control programmes for both illnesses. We estimated that, in 2010, there were 1·731 billion episodes of diarrhoea (36 million of which progressed to severe episodes) and 120 million episodes of pneumonia (14 million of which progressed to severe episodes) in children younger than 5 years. We estimated that, in 2011, 700 000 episodes of diarrhoea and 1·3 million of pneumonia led to death. A high proportion of deaths occurs in the first 2 years of life in both diseases—72% for diarrhoea and 81% for pneumonia. The epidemiology of childhood diarrhoea and that of pneumonia overlap, which might be partly because of shared risk factors, such as undernutrition, suboptimum breastfeeding, and zinc deficiency. Rotavirus is the most common cause of vaccine-preventable severe diarrhoea (associated with 28% of cases), and Streptococcus pneumoniae (18·3%) of vaccine-preventable severe pneumonia. Morbidity and mortality from childhood pneumonia and diarrhoea are falling, but action is needed globally and at country level to accelerate the reduction.
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                Author and article information

                Int J Environ Res Public Health
                Int J Environ Res Public Health
                International Journal of Environmental Research and Public Health
                25 May 2018
                June 2018
                : 15
                : 6
                [1 ]School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai 200093, China; changjingcj2004@
                [2 ]Department of Thermal Energy and Power Engineering, Shandong Jiaotong University, Jinan 250357, China
                [3 ]Department of Building Science, Tsinghua University, Beijing 100084, China; lw1987@
                [4 ]Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Tsinghua University, Beijing 100084, China
                Author notes
                © 2018 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (


                Public health

                children, traffic, residence, pneumonia, china


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