J Neurogastroenterol Motil 2019; 25(2): 241-249  
Is Long-term Ambient Air Pollutant Exposure a Risk Factor for Irritable Bowel Syndrome in Children? A 12-year Longitudinal Cohort Study
Teck-King Tan,1 Miguel Saps,2 Cheng-Li Lin,3,4 and Chang-Ching Wei5,6*
1Division of Pediatric Gastroenterology, Department of Pediatrics, Children’s Hospital, China Medical University Hospital, Taichung, Taiwan; 2Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Miami Health System, FL, USA; 3Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; 4Department of Public Health, China Medical University, Taichung, Taiwan; 5Division of Pediatric Allergy, Immunology, and Rheumatology, Department of Pediatrics, Children’s Hospital, China Medical University Hospital, Taichung, Taiwan; and 6School of Medicine, China Medical University, Taichung, Taiwan
Correspondence to: *Chang-Ching Wei, MD
Division of Pediatric Allergy, Immunology, and Rheumatology, Department of Pediatrics, Children’s Hospital, China Medical University Hospital, School of Medicine, China Medical University, No. 2, Yu-Der Road, Taichung 40402, Taiwan, Tel: +886-4-22052121-4639, Fax: +886-4-2203-2798, E-mail: weilonger@gmail.com
Received: August 3, 2018; Revised: November 27, 2018; Accepted: March 4, 2019; Published online: April 30, 2019.
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

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Abstract
Background/Aims: Recent studies suggest that air pollution may play a role in gastrointestinal disorders. However, the effect of long-term exposure to air pollution on childhood irritable bowel syndrome (IBS) is unclear. Hence, we conducted a nationwide cohort study to investigate the association between long-term air pollution exposure and the incidence and risk of IBS in Taiwanese children during 2000-2012.
Methods: We collected data from the Taiwan National Health Insurance Research Database, linked to the Taiwan Air Quality-Monitoring Database according to the insurant living area and the air quality-monitoring station locations. Children < 18 years old, identified from January 1st, 2000, were followed-up until IBS diagnosis or December 31st, 2012. The daily average air pollutant concentrations were categorized into 4 quartile-based groups (Q1-Q4). We measured the incidence rate, hazard ratios (HRs), and 95% confidence intervals for IBS stratified by the quartiles of air pollutant concentration.
Results: A total of 3537 children (1.39%) were diagnosed with IBS within the cohort during the follow-up period. The incidence rate for IBS increased from 0.84 to 1.76, from 0.73 to 1.68, from 0.85 to 1.98, and from 0.52 to 3.22 per 1000 person-years, with increase in the carbon monoxide, nitrogen dioxide, non-methane hydrocarbon, and methane quartile (from Q1 to Q4) exposure concentration, respectively. The adjusted HR for IBS increased with elevated carbon monoxide, nitrogen dioxide, non-methane hydrocarbon, and methane exposure in Q4 to 1.98, 2.14, 2.19, and 5.87, respectively, compared with Q1.
Conclusion: Long-term ambient air pollutant exposure is an environmental risk factor for childhood IBS.
Keywords: Air pollutant; Child; Irritable bowel syndrome; Follow-up studies


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