Emergency department visits of young children and long-term exposure to neighbourhood smoke from household heating – The Growing Up in New Zealand child cohort study

In developed countries, exposure to wood or coal smoke occurs predominantly from neighbourhood emissions arising from household heating. The effect of this exposure on child health is not well characterized. Within a birth cohort study in New Zealand we assessed healthcare events associated with exposure to neighbourhood smoke from household heating. Our outcome measure was non-accidental presentations to hospital emergency departments (ED) before age three years. We matched small area-level census information with the geocoded home locations to measure the density of household heating with wood or coal in the neighbourhood and applied a time-weighted average exposure method to account for residential mobility. We then used hierarchical multiple logistic regression to assess the independence of associations of this exposure with ED presentations adjusted for gender, ethnicity, birth weight, breastfeeding, immunizations, number of co-habiting smokers, wood or coal heating at home, bedroom mold, household- and area-level deprivation and rurality. The adjusted odds ratio of having a non-accidental ED visit was 1.07 [95%CI: 1.03–1.12] per wood or coal heating household per hectare. We found a linear dose-response relationship (p-value for trend = 0.024) between the quartiles of exposure (1st as reference) and the same outcome (odds ratio in 2nd to 4th quartiles: 1.14 [0.95–1.37], 1.28 [1.06–1.54], 1.32 [1.09–1.60]). Exposure to neighbourhoods with higher density of wood or coal smoke-producing households is associated with an increased odds of ED visits during early childhood. Policies that reduce smoke pollution from domestic heating by as little as one household per hectare using solid fuel burners could improve child health.