Exposure to residential mold and dampness and the associations with respiratory tract infections and symptoms thereof in children in high income countries: A systematic review and meta-analyses of epidemiological studies.

BACKGROUND: Multiple reviews have been conducted on the associations between residential mold and dampness and respiratory outcomes in children, with few specifically investigating respiratory tract infections (RTIs). OBJECTIVE: We aimed to review and synthesize the available epidemiological literature on mold and dampness and risk of RTIs and respiratory symptoms compatible with RTIs in children living in high-income countries. METHOD: We performed a systematic search of literature available from MEDLINE, Embase, and Web of Science for observational studies. We conducted meta-analyses using two-level random effects (RE) and multi-level random effects (ML) models for contrasts of three exposure and three outcome categories, including multiple estimates reported by single studies. We report central estimates for pooled odds ratios (OR) and 95 % confidence intervals (CI).We conducted a risk of bias assessment using the Joanna Briggs Initiative (JBI) checklists for cross-sectional, case-control, and cohort studies. We additionally report on cumulative meta-analyses, leave-one-out analyses of single estimates, subgroup analyses by study quality and study design and inclusion of all effect estimates. RESULTS: Of the 932 studies initially screened by title and abstract, we included 30 studies with 267 effect estimates that met the inclusion criteria. Most were cross-sectional (n = 22), with fewer cohort (n = 5) and case-control (n = 3) studies. Most of the studies were according to the bias assessment of poor or fair quality (n = 24). The main meta-analyses generally provided similar results regardless of statistical model and central estimates ranged from OR 1.28 (95 % CI; 1.08, 1.53) for dampness and RTIs to OR 1.76 (95 % CI; 1.64, 1.88) for mold and respiratory symptoms. Most analyses were of moderate heterogeneity. Funnel plots did not indicate strong publication bias. CONCLUSION: Our results are compatible with a weak to moderate effect of residential mold and or dampness on risk of RTIs in children in high-income countries. However, these results are based primarily on cross-sectional studies.

Association of indoor dampness indicators with rheumatic diseases/symptoms in older adults: A comparative cross-sectional study in Chongqing and Beijing.

Dampness is strongly associated with rheumatic diseases, which particularly affect the older adults. Tackling dampness is therefore important, especially given that climate change is expected to exacerbate rheumatic diseases; however, limited studies have compared the risk of rheumatic diseases in older adults based on humidity levels across different regions. To explore this, a comparative cross-sectional study was conducted to collect information on the residential characteristics, lifestyles, and health outcomes of 2000 individuals aged 60-74 years from Chongqing and Beijing. From this data, we tested for an association between six indoor dampness indicators and rheumatic related diseases/symptoms. The results showed that the risk values for joint pain were higher in Chongqing than in Beijing. Moreover, the risk of joint stiffness increased more strongly in Chongqing than in Beijing as the cumulative number of dampness exposure indicators increased. The key indoor dampness indicators affecting rheumatic diseases were different for Chongqing and Beijing. Overall, this study compared the risk of rheumatic diseases in older adults in the north and south of China because of dampness exposure and, from these, provided suggestions for modifying the indoor environments to prevent or reduce rheumatic symptoms.

Residential Exposure to Dampness Is Related to Reduced Level of Asthma Control among Adults.

We assessed potential relations between indicators of indoor dampness and mold exposures at home and the level of asthma control among adults. The present population-based cross-sectional study, the Northern Finnish Asthma Study (NoFAS), included 1995 adult subjects with bronchial asthma who replied to study questionnaires (response rate: 40.4%). The Asthma Control Test (ACT) was used as the measure of asthma control. We calculated the mean difference in ACT score (ACTdifference) and the risk ratio (RR) of poor asthma control (ACT ≤ 19) for the exposure and reference groups and applied Poisson regression to adjust for potential confounding. Exposure to indoor dampness at home was related to a significantly reduced level of asthma control (ACTdifference: -0.83, 95% CI: -1.60 to -0.07), especially among men (ACTdifference: -2.68, 95% CI: -4.00 to -1.37). Water damage (aRR = 1.29, 95% CI: 1.01, 1.65) and indoor dampness, especially among men (aRR = 1.92, 95% CI: 1.15, 3.20), increased the risk of poor asthma control. We provide evidence that exposure to indoor dampness at home reduces asthma control among adults, especially in men. Indoor visible mold and mold odor were not significantly related to asthma control. Advice on how to prevent indoor dampness at home should be an important part of asthma management.

Respiratory health among Korean pupils in relation to home, school and outdoor environment.

There are few studies about school-environment in relation to pupils' respiratory health, and Korean school-environment has not been characterized. All pupils in 4th grade in 12 selected schools in three urban cities in Korea received a questionnaire (n = 2,453), 96% participated. Gaseous pollutants and ultrafine particles (UFPs) were measured indoors (n = 34) and outdoors (n = 12) during winter, 2004. Indoor dampness at home was investigated by the questionnaire. To evaluate associations between respiratory health and environment, multiple logistic- and multi-level regression models were applied adjusting for potential confounders. The mean age of pupils was 10 yr and 49% were boys. No school had mechanical ventilation and CO(2)-levels exceeded 1,000 ppm in all except one of the classrooms. The indoor mean concentrations of SO(2), NO(2), O(3) and formaldehyde were 0.6 µg/m(3), 19 µg/m(3), 8 µg/m(3) and 28 µg/m(3), respectively. The average level of UFPs was 18,230 pt/cm(3) in the classrooms and 16,480 pt/cm(3) outdoors. There were positive associations between wheeze and outdoor NO(2), and between current asthma and outdoor UFPs. With dampness at home, pupils had more wheeze. In conclusion, outdoor UFPs and even low levels of NO(2) may adversely contribute to respiratory health in children. High CO(2)-levels in classrooms and indoor dampness/mold at home should be reduced.