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Original Research: ASTHMA |

Influence of Socioeconomic Deprivation on the Relation Between Air Pollution and β-Agonist Sales for Asthma

Olivier Laurent, PhD; Gaëlle Pedrono, MSc; Laurent Filleul, PhD; Claire Segala, MD; Agnès Lefranc, PhD; Charles Schillinger, MSc; Emmanuel Rivière, MSc; Denis Bard, MD
Author and Funding Information

*From LERES (Drs. Laurent and Bard), Ecole des Hautes Etudes en Santé Publique, Rennes; SEPIA Santé (Ms. Pedrono and Dr. Segala), Baud; CIRE Aquitaine (Dr. Filleul), Institut de Veille Sanitaire, Bordeaux; Département Santé Environnement (Dr. Lefranc), Institut de Veille Sanitaire, Saint Maurice; Association pour la Surveillance et l'Etude de la Pollution Atmosphérique en Alsace (Mr. Schillinger and Mr. Rivière), Schiltigheim.

Correspondence to: Dr. Denis Bard, Laboratoire d'Etude et de Recherche en Environnement et Santé (LERES), École des Hautes Études en Santé Publique, Av du Pr Léon Bernard, F-35043 Rennes cedex, France; e-mail: denis.bard@ehesp.fr


The work was performed at the French School of Public Health (Ecole des Hautes Etudes en Santé Publique).

This proposal was funded by the French National Research Agency (Agence Nationale de la Recherche) grant ANR SEST 00057 05.

The authors have no conflict of interest to disclose.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2009;135(3):717-723. doi:10.1378/chest.08-1604
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Background:  Air pollution triggers asthma attacks hours to days after exposure. It remains unclear whether socioeconomic deprivation modulates these effects. Investigation of these interactions requires adequate statistical power, obtainable by using either a sufficient number of observations or very sensitive indicators of asthma attacks. Using a small-area temporal ecologic approach, we studied the short-term relations between ambient air pollution and sales of short-acting β-agonist (SABA) drugs, a frequent and specific treatment for control of asthma attacks in children and young adults, and then tested the influence of deprivation on these relations.

Methods:  The study took place in Strasbourg, France in 2004. Health insurance funds provided data on 15,121 SABA sales for patients aged 0 to 39 years. Deprivation was estimated by small geographic areas using an index constructed from census data. Daily average ambient concentrations of particulate matter (particles with an aerodynamic diameter < 10 μm [PM10]), nitrogen dioxide (NO2), and ozone (O3) were modeled on a small-area level. Adjusted case-crossover models were used for statistical analysis.

Results:  Increased of 10 μg/m3 in ambient PM10, NO2, and O3 concentrations were associated, respectively, with increases of 7.5% (95% confidence interval [CI], 4 to 11.2%), 8.4% (95% CI, 5 to 11.9%), and 1% (95% CI, − 0.3 to 2.2%) in SABA sales. Deprivation had no influence on these relations.

Conclusion:  The associations observed are consistent with those reported by studies focusing on SABA use. Similar studies in other settings should confirm whether the lack of interaction with deprivation is due to specific local conditions.

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