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Vol. 89. Num. 2.01 August 2018
Pages 77-124
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Vol. 89. Num. 2.01 August 2018
Pages 77-124
Original Article
DOI: 10.1016/j.anpede.2017.06.010
Impact of air pollution in paediatric consultations in Primary Health Care: Ecological study
Impacto de la contaminación ambiental en las consultas pediátricas de Atención Primaria: estudio ecológico
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Raquel Martín Martína, Marciano Sánchez Bayleb,
Corresponding author
msanba49@gmail.com

Corresponding author.
a Centro de Salud Reina Victoria, Madrid, Spain
b Sección de Pediatría, Hospital Infantil del Niño Jesús, Madrid, Spain
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Statistics
Tables (4)
Table 1. Descriptive statistics.
Table 2. Spearman correlation coefficients for the comparison of the variables under study (showing only those for statistically significant correlations).
Table 3. Monthly number of visits due to respiratory complaints based on whether the mean NO2 level of the month was less than or equal to or greater than 40μg/m3.
Table 4. Results of the multiple linear regression analysis of PC visits due to respiratory problems.
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Abstract
Objective

To study the correlation between the levels of environmental pollutants and the number of paediatric consultations related to respiratory disease in Primary Health Care.

Patients and methods

An ecological study is performed, in which the dependent variable analysed was the number of paediatric consultations in an urban Primary Health Care centre in Madrid over a 3 year period (2013–2015), and specifically the consultations related to bronchiolitis, recurrent bronchospasm, and upper respiratory diseases. The independent variables analysed were the levels of environmental pollutants. Coefficients of correlation and multiple lineal regressions were calculated. An analysis has been carried out comparing the average of paediatric consultations when the levels of nitrogen dioxide (NO2) were higher and lower than 40μg/m3.

Results

During the period of the study, there were a total of 52,322 paediatric consultations in the health centre, of which 6,473 (12.37%) were related to respiratory diseases. A positive correlation was found between SO2, CO, NOx and NO2 and benzene levels and paediatric consultations related to respiratory diseases, and a negative correlation with temperature. The number of consultations was significantly higher when NO2 levels exceeded 40μg/m3. In the multiple lineal regression (P=.0001), the correlation was only positive between consultations and NO2 levels (3.630, 95% CI: 0.691–6.570), and negative with temperature (−5.957, 95% CI: −8.665 to −3.248).

Conclusions

NO2 environmental pollution is related to an increase in respiratory diseases in children. Paediatricians should contribute to promote an improvement in urban air quality as a significant preventive measure.

Keywords:
Environmental pollution
Respiratory diseases
Primary care
Resumen
Objetivo

Estudiar la relación existente entre los niveles de contaminantes ambientales y la demanda por enfermedad respiratoria en las consultas pediátricas de Atención Primaria.

Pacientes y métodos

Estudio ecológico en el que la variable dependiente analizada ha sido la demanda en las consultas pediátricas de un centro de salud urbano de Madrid durante 3 años (2013-2015) por bronquiolitis, episodios de broncoespasmo y procesos respiratorios de vías altas. Como variables independientes se estudiaron los valores de contaminación ambiental. Se calcularon coeficientes de correlación y regresión lineal múltiple. Se comparó el promedio de consultas cuando los valores de dióxido de nitrógeno (NO2) eran superiores e inferiores a 40μg/m3.

Resultados

Durante el periodo de tiempo estudiado hubo un total de 52.322 consultas pediátricas en el centro de salud, de las cuales 6.473 (12,37%) lo fueron por procesos respiratorios. Se encontró correlación positiva entre los niveles de SO2, CO, NO2, NOx, benceno y el número de consultas por procesos respiratorios y negativa con la temperatura y el O3. El número de consultas por enfermedad respiratoria fue significativamente mayor cuando los niveles de NO2 superaban los 40μg/m3. En la regresión lineal múltiple (p<0,0001) solo se mantuvo la relación positiva de las consultas con los niveles de NO2 (3,630; IC 95%: 0,691-6,570) y negativa con la temperatura (−5,957; IC 95%: −8,665 a −3,248).

Conclusiones

La contaminación ambiental por NO2 está relacionada con el aumento de la enfermedad respiratoria en la infancia. Los pediatras deberíamos contribuir a propiciar la mejora de la calidad del aire como una importante medida preventiva.

Palabras clave:
Contaminación ambiental
Enfermedades respiratorias
Atención primaria

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