Effect of radon exposure on asthma morbidity in the School Inner-City Asthma study.

BACKGROUND: Radon may have a role in obstructive lung disease outside its known carcinogenicity. Little is known about radon's effects on asthma morbidity. OBJECTIVE: To determine the effect of radon on fractional exhaled nitric oxide (FE NO), asthma symptom-days, and lung function in inner-city asthmatic school children. METHODS: Two hundred ninety-nine school-aged asthmatic children enrolled in the School Inner-City Asthma Study (SICAS-1) were followed. One and two-month averaged radon was assessed using a spatiotemporal model predicting zip code-specific monthly exposures. FE NO and spirometry were measured twice during the academic year. Asthma symptoms were assessed four times during the academic year. The interaction between indoor radon exposure (Bq/m3 ) and seasonality predicting log-transformed FE NO, forced expiratory volume in 1 s (FEV1 ) % predicted, forced vital capacity (FVC) % predicted, FEV1 /FVC, and asthma symptom-days was evaluated. RESULTS: Participants with high radon exposure had greater change in FE NO from warm to cold periods compared to low radon exposure (interaction p = 0.0013). Participants with >50th percentile radon exposure experience significant FE NO increase from warm to cold weather ( ß $\beta $ = 0.29 [95% confidence interval [CI]: 0.04-0.54], p = 0.0240). We report a positive association between radon 1-month moving average (incidence rate ratio [IRR] = 1.01, p = 0.0273) and 2-month moving average (IRR = 1.01, p = 0.0286) with maximum asthma symptom-days (n = 299, obs = 1167). CONCLUSIONS: In asthmatic children, radon may be associated with increased asthma morbidity, suggesting radon may be a modifiable environmental risk factor for airway inflammation.

Predictors of indoor radon levels in the Midwest United States.

Radon (Rn) is a natural and toxic radioactive gas that accumulates indoors, mainly in low-ventilated underground floors and basements. Several factors make prediction of indoor Rn exposure in enclosed spaces challenging. In this study, we investigated the influence of soil, geology, topography, atmospheric variables, radiation, urbanization, community economic well-being, and monthly and yearly variations on indoor Rn concentrations. We analyzed 7,515 monthly indoor Rn measurements in 623 zip codes from two U.S. States (Michigan and Minnesota) during 2005-2018 using a random forest model. Using Shapley Additive exPlanations (SHAP) values we investigated the contribution of each factor using variable importance and partial dependence plots. Factors that predict indoor Rn differed between states, with topographical, geological and soil composition being most influential. Cross-validated Pearson correlation between predictions and measurements was 0.68 (RMSE = 47.8 Bq/m3) in Minnesota, and 0.67 (RMSE = 52.5 Bq/m3) in Michigan. Our results underline the importance of soil structure for radon exposure, presumably due to strapped Rn in soil. The differences across states also suggest that Rn studies performing model development should consider geographical variables, along with other factors. As indoor Rn levels are multifactorial, an understanding of the factors that influence its emanation and build up indoors will help better assess spatial and temporal variations, which will be useful to improve prevention and mitigation control strategies.Implications: Radon exposure has become a year-round problem as people spend most of their time indoors. In North America, radon exposure is increasing over time and awareness related to its health effects remains low in the general population. Several factors make prediction of indoor radon exposure in enclosed spaces challenging. In this study, we used random forest to investigate the influence of factors on indoor radon in the Midwest United States. We found that topography, geology, and soil composition were the most influential factors on indoor radon levels. These results will help better assess spatial and temporal variations, which will further help better prevention and mitigation control strategies.