Association between Kawasaki Disease and Prenatal Exposure to Ambient and Industrial Air Pollution: A Population-Based Cohort Study

Buteau, Stéphane; Belkaibech, Sabrina; Bilodeau-Bertrand, Marianne; Hatzopoulou, Marianne; Smargiassi, Audrey; Auger, Nathalie

doi:10.1289/ehp6920

Cited by 10 publications

(7 citation statements)

References 55 publications

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“…However, the fact that SWC components altogether account at most for around 20% of the overall KD variability, denotes that the factors associated with SWC 1 are, however, not sufficient to determine alone a KD outcome. The former is in vast agreement with other studies where seasonal-to-interannual changes were studied as the main source of KD variability (Ballester et al 2013, Buteau et al 2020, but our study sets the numerical basis to substantiate this assertion. For instance, while the three large epidemics might be related to climate extremes in the source region (e.g.…”

Section: Discussionsupporting

confidence: 92%

Sub-weekly signatures relate ultrafine aerosols enriched in metals from intensive farming and urban pollution to Kawasaki disease

Rodó

Navarro-Gallinad

Kojima

et al. 2023

Environ. Res. Lett.

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Air pollution (urban, industrial or rural) has been linked to a myriad human ailment despite clear mechanistic associations are not often thoroughly established. Daily variability of fine aerosols in a surveillance campaign in south Japan shows a striking coevolution between their trace elements (metal and metalloid, MM) content and Kawasaki Disease (KD) admissions, suggesting a strong dynamical link. These aerosol MM could instigate an immune response that along with genetic susceptibility, would lead to KD development. This association may account to over 40% of the total variability in the disease, being dominated by a clear sub-weekly cycle (SWC1). Thanks to both an unprecedented daily KD epidemiological record going back to 1970, Light Detection and Ranging (LIDAR) atmospheric backscattering profiles for the interval 2010-2016 and HYSPLIT simulations with numerous sensitivity analyses, we can trace this SWC1 variability to occur concomitantly from sub-seasonal to interannual timescales in both KD and aerosols. This SWC1 appears to connect or disconnect Japan to air intrusions from above the planetary boundary layer (PBL), having their source in industrial and agricultural areas in NE Asia and points to a stronger case for an agricultural source for the exposure as opposed to urban pollution. KD maxima always occur in full synchrony with the arrival of very small (<1 µm; PM1) particles showing that ultrafine aerosols appear as a necessary cofactor in the occurrence of KD and sets the field to associate other similar human diseases. Our study shows how signal-detection approaches can be useful to uncover hidden associations between the environment and human health, otherwise unnoticed and help set new early-warning systems for disease prevention.

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Section: Discussionsupporting

confidence: 92%

Sub-weekly signatures relate ultrafine aerosols enriched in metals from intensive farming and urban pollution to Kawasaki disease

Rodó

Navarro-Gallinad

Kojima

et al. 2023

Environ. Res. Lett.

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“…39,40 The cause of this variation remains unclear, and may be related to genetic or environmental predisposition. [41][42][43] Genetic polymorphisms and environmental factors have been implicated in the development of KD, and could play a similar role in MIS-C. [44][45][46] The artificial nature of racial and ethnic grouping as a social and political construct limits conclusions regarding the role of population genetics in our findings. 47,48 It is, however, well documented that inequities in environmental exposure exist based on race/ethnicity and SES.…”

Section: Discussionmentioning

confidence: 89%

Socioeconomic and Racial and/or Ethnic Disparities in Multisystem Inflammatory Syndrome

et al. 2021

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This is a prepublication version of an article that has undergone peer review and been accepted for publication but is not the final version of record. This paper may be cited using the DOI and date of access. This paper may contain information that has errors in facts, figures, and statements, and will be corrected in the final published version. The journal is providing an early version of this article to expedite access to this information. The American Academy of Pediatrics, the editors, and authors are not responsible for inaccurate information and data described in this version.

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“…Furthermore, immune complexes are now considered to be playing an important role in the pathogenesis of KD 19 . Attention has been given to the possibility of ambient air pollutions triggering KD 20 , 21 . Both NOx and CO are predominantly traffic-related emissions 22 , 23 .…”

Section: Discussionmentioning

confidence: 99%

“…Only the data of PSI were presented as a scale extending from 0 (healthy) to 500 (extremely unhealthy) since PSI is calculated according to five sub-index (SO2, NO2, O3, CO, and PM10). Previous articles regarding prenatal and early life exposure to air pollution and KD demonstrated the confounding factors such as age, gender, birth weight, mother age, mode of delivery and preterm delivery, which were then applied in our study 21 , 28 . Maternal comorbidity including asthma, allergic rhinitis and atopic dermatitis were selected in the list of confounders since previous literature illustrated that children born from mothers with asthma and allergic rhinitis had a higher risk of developing KD 40 .…”

Section: Discussionmentioning

confidence: 99%

Prenatal and early life exposure to air pollution and the incidence of Kawasaki disease

Kuo

Lin

2022

Sci Rep

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Kawasaki disease (KD) is the most common form of acquired pediatric cardiac disease in the developed world. However, its etiology is still unclear. Epidemiological studies have shown that air pollution is a plausible risk factor in stimulating oxidative stress, inducing inflammation and causing autoimmune diseases. This study aims to assess the connections between prenatal and early life air pollution exposure to the incidence of KD. The main data source of this nationwide longitudinal study was the National Health Insurance Research Database (NHIRD) of Taiwan. NHIRD was linked with Taiwan Maternal and Child Health Database to establish the link between mothers and children. In total, 4192 KD cases involving children under 6 years of age were identified between January 2004 and December 2010. Children in the control group were randomly selected at a 1:4 ratio and matched using their age and index year. Integrated data for the air pollutants were obtained from 71 Environmental Protection Agency monitoring stations across Taiwan. Patients who had main admission diagnosis of KD and subsequently received intravenous immunoglobulin treatment were defined as incidence cases. Ambient exposure, including pollutant standards index (PSI), carbon monoxide (CO), nitric oxide (NO), nitric dioxide (NO2), and nitrogen oxide (NOx) during pregnancy were all positively associated with KD incidence. Conversely, ozone (O3) exposure had a negative correlation. Exposure to CO, NO, NO2, and NOx after childbirth remained consistent with regards to having a positive association with KD incidence. Exposure to PSI and O3 after delivery displayed no significant association with KD. Both prenatal and postnatal cumulative CO, NO, NO2, and NOx exposure had a dose dependent effect towards increasing KD incidence. Certain prenatal and early life air pollutant exposure may increase the incidence of KD.

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Association between Kawasaki Disease and Prenatal Exposure to Ambient and Industrial Air Pollution: A Population-Based Cohort Study

Cited by 10 publications

References 55 publications

Sub-weekly signatures relate ultrafine aerosols enriched in metals from intensive farming and urban pollution to Kawasaki disease

Sub-weekly signatures relate ultrafine aerosols enriched in metals from intensive farming and urban pollution to Kawasaki disease

Socioeconomic and Racial and/or Ethnic Disparities in Multisystem Inflammatory Syndrome

Prenatal and early life exposure to air pollution and the incidence of Kawasaki disease

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