TY - JOUR
T1 - Residential green space and medication sales for childhood asthma
T2 - A longitudinal ecological study in Belgium
AU - Aerts, Raf
AU - Dujardin, Sebastien
AU - Nemery, Benoit
AU - Van Nieuwenhuyse, An
AU - Van Orshoven, Jos
AU - Aerts, Jean Marie
AU - Somers, Ben
AU - Hendrickx, Marijke
AU - Bruffaerts, Nicolas
AU - Bauwelinck, Mariska
AU - Casas, Lidia
AU - Demoury, Claire
AU - Plusquin, Michelle
AU - Nawrot, Tim S.
N1 - Funding Information:
This research has received funding from the Belgian Science Policy Office (BELSPO) through the Belgian Research Action through Interdisciplinary Networks (BRAIN-be) projects RespirIT and GRESP-HEALTH under grant agreement numbers BR/154/A1/RespirIT and BR/143/A3/GRESP-HEALTH . This research has received additional funding from the Mycology and Aerobiology service of Sciensano . LC and MB are recipients of a postdoctoral and doctoral fellowship (grant numbers 12I1517N and 11A9718N ) of the Research Foundation Flanders (FWO).
Funding Information:
Environmental exposures to traffic-related air pollution, fungi, second-hand tobacco smoke, and aeroallergens, in combination with genetic predisposition and early life exposure to antibiotics, are major risk factors for developing and exacerbating allergic and non-allergic asthma (Flamant-Hulin et al., 2013; Dannemiller et al., 2016; Liu et al., 2016; T?treault et al., 2016; Khreis et al., 2017; Papi et al., 2018; Guilbert et al., 2018; Eguiluz-Gracia et al., 2019; Murrison et al., 2019; Parmes et al., 2020; Buteau et al., 2020; Patrick et al., 2020). Vegetation may have the potential to mitigate some of these harmful environmental exposures and could therefore protect against asthma and other respiratory conditions (Tischer et al., 2017; Squillacioti et al., 2019; Fuertes et al., 2020). For instance, urban green spaces may mitigate outdoor air pollution and hereby prevent asthma exacerbations (Markevych et al., 2017). Urban green spaces may also facilitate asthma control by reducing stress or improving physical activity (DePriest et al., 2019). Furthermore, according to the biodiversity hypothesis, biodiversity in green spaces may support the immune system through beneficial effects on the composition and diversity of the human microbiome, and hereby protect against the development of chronic inflammatory diseases, including asthma (Hanski et al., 2012; Haahtela et al., 2013).This study used health care data from the Belgian social security agency InterMutualistisch Agentschap-L'Agence InterMutualiste (IMA-AIM). The IMA-AIM manages health care data collected by the seven Belgian health insurance funds. In Belgium, health insurance is mandatory and the population in the IMA-AIM database corresponds to about 98% of the Belgian population (as registered in the national register). The IMA-AIM provided data on reimbursed medication sales for obstructive airway disease (OAD) from 2010 to 2014. The data included the number of individuals aged 6?18 years old per census tract and per year for whom at least one refundable medication was prescribed at least once during the study period (2010?2014) as well as the number of registered individuals aged 6?18 years old per census tract (Fig. 2). OAD medication was defined as all reimbursed drugs included in the ATC (Anatomical Therapeutic Chemical) code R03 (medication for OAD: adrenergic inhalants, adrenergics for systemic use and other inhalants and systemic drugs for OAD). These drugs include short-acting and long-acting ?-agonists (bronchodilators) as well as inhaled corticosteroids (ICS) to treat asthma in children (Guilbert et al., 2014). The sales of these drugs to treat chronic obstructive pulmonary disease (COPD) in adults are not within the scope of this study. The aggregated data did not contain information on the frequency of use. Census tracts with no more than 5 reimbursed persons in at least one year during the study period were excluded by IMA-AIM due to privacy reasons. All health data were used under license of IMA-AIM and the protocol for this study did not require ethics approval or consent to participate.The parameter estimates from the adjusted models based on the 5-year average period prevalence did not vary much from those of the fully-adjusted repeated measures models and supported the associations between grassland and garden cover and OAD medication sales (Table S2).The research data is confidential. The land cover data that were used to quantify residential green space (Top10Vector, identifier BE.NGI-IGN/5F4130E6-DF5C-41E6-A956-BB9F04088D11) are copyrighted (?Institut G?ographique National) and were used under federal use license 2016_F014 granted by the Institut G?ographique National (NGI-IGN) to the Belgian Science Policy Office (BELSPO).This research has received funding from the Belgian Science Policy Office (BELSPO) through the Belgian Research Action through Interdisciplinary Networks (BRAIN-be) projects RespirIT and GRESP-HEALTH under grant agreement numbers BR/154/A1/RespirIT and BR/143/A3/GRESP-HEALTH. This research has received additional funding from the Mycology and Aerobiology service of Sciensano. LC and MB are recipients of a postdoctoral and doctoral fellowship (grant numbers 12I1517N and 11A9718N) of the Research Foundation Flanders (FWO).
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/10
Y1 - 2020/10
N2 - Background: Living in green environments has been associated with various health benefits, but the evidence for positive effects on respiratory health in children is ambiguous. Objective: To investigate if residential exposure to different types of green space is associated with childhood asthma prevalence in Belgium. Methods: Asthma prevalence was estimated from sales data of reimbursed medication for obstructive airway disease (OAD) prescribed to children between 2010 and 2014, aggregated at census tract level (n = 1872) by sex and age group (6–12 and 13–18 years). Generalized log-linear mixed effects models with repeated measures were used to estimate effects of relative covers of forest, grassland and garden in the census tract of the residence on OAD medication sales. Models were adjusted for air pollution (PM10), housing quality and administrative region. Results: Consistent associations between OAD medication sales and relative covers of grassland and garden were observed (unadjusted parameter estimates per IQR increase of relative cover, range across four strata: grassland, β = 0.15–0.17; garden, β = 0.13–0.17). The associations remained significant after adjusting for housing quality and chronic air pollution (adjusted parameter estimates per IQR increase of relative cover, range across four strata: grassland, β = 0.10–0.14; garden, β = 0.07–0.09). There was no association between OAD medication sales and forest cover. Conclusions: Based on aggregated data, we found that living in close proximity to areas with high grass cover (grasslands, but also residential gardens) may negatively impact child respiratory health. Potential allergic and non-allergic mechanisms that underlie this association include elevated exposure to grass pollen and fungi and reduced exposure to environmental biodiversity. Reducing the dominance of grass in public and private green space might be beneficial to reduce the childhood asthma burden and may simultaneously improve the ecological value of urban green space.
AB - Background: Living in green environments has been associated with various health benefits, but the evidence for positive effects on respiratory health in children is ambiguous. Objective: To investigate if residential exposure to different types of green space is associated with childhood asthma prevalence in Belgium. Methods: Asthma prevalence was estimated from sales data of reimbursed medication for obstructive airway disease (OAD) prescribed to children between 2010 and 2014, aggregated at census tract level (n = 1872) by sex and age group (6–12 and 13–18 years). Generalized log-linear mixed effects models with repeated measures were used to estimate effects of relative covers of forest, grassland and garden in the census tract of the residence on OAD medication sales. Models were adjusted for air pollution (PM10), housing quality and administrative region. Results: Consistent associations between OAD medication sales and relative covers of grassland and garden were observed (unadjusted parameter estimates per IQR increase of relative cover, range across four strata: grassland, β = 0.15–0.17; garden, β = 0.13–0.17). The associations remained significant after adjusting for housing quality and chronic air pollution (adjusted parameter estimates per IQR increase of relative cover, range across four strata: grassland, β = 0.10–0.14; garden, β = 0.07–0.09). There was no association between OAD medication sales and forest cover. Conclusions: Based on aggregated data, we found that living in close proximity to areas with high grass cover (grasslands, but also residential gardens) may negatively impact child respiratory health. Potential allergic and non-allergic mechanisms that underlie this association include elevated exposure to grass pollen and fungi and reduced exposure to environmental biodiversity. Reducing the dominance of grass in public and private green space might be beneficial to reduce the childhood asthma burden and may simultaneously improve the ecological value of urban green space.
KW - Environmental epidemiology
KW - Medication sales
KW - Pediatric asthma
KW - Residential green space
KW - Respiratory health
UR - http://www.scopus.com/inward/record.url?scp=85088137434&partnerID=8YFLogxK
U2 - 10.1016/j.envres.2020.109914
DO - 10.1016/j.envres.2020.109914
M3 - Article
AN - SCOPUS:85088137434
SN - 0013-9351
VL - 189
JO - Environmental Research
JF - Environmental Research
M1 - 109914
ER -
