Combining satellite remote sensing, chemical transport modeling, and land use regression models to estimate long term trends in global burden of NO2 on pediatric asthma incidence

Traffic-related air pollution (TRAP) is associated with new asthma incidence, particularly among children under 18 years. A recent study found that approximately 13% of pediatric asthma incidence globally in 2015 could be attributable to nitrogen dioxide (NO2), a common proxy for TRAP. To facilitate inclusion of NO2 - pediatric asthma estimates in the Global Burden of Disease, temporal trends in exposure are required. While satellite remote sensing has been used to observe trends in NO2 concentrations globally over the last 15 years, long term trends in the burden of NO2 on asthma incidence have not been studied. Here, we investigate trends in the global burden of NO2 and associated pediatric asthma incidence from 1990 to 2017 at 100m resolution using satellite observations (GOME, GOME-2, SCIAMACHY, and OMI), combined with chemical transport modeling and a land-use regression model. Combining these new global, long-term, and high-resolution estimates of NO2 concentrations with population datasets, national asthma incidence rates, and epidemiological concentration-response functions, we assess the burden of NO2 on pediatric asthma incidence in each country globally for four different pediatric age (1-4, 5-9, 10-14, and 15-18 years old) over 1990-2018. Methods are designed to be consistent with the Global Burden of Disease study for potential future inclusion into their comparative risk assessment framework. Results can be used to help target global, national, and sub-national policies aimed at mitigating pollution and the global asthma burden, and to identify vulnerable age groups, countries, and urban/rural populations.