Final Report: Associations of Short-Term Pollution Exposures with Childhood Autoimmune Disease

EPA Grant Number: R834992
Title: Associations of Short-Term Pollution Exposures with Childhood Autoimmune Disease
Investigators: Zeft, Andrew S. , Pope, Clive Arden
Institution: Cleveland Clinic Foundation , Brigham Young University
EPA Project Officer: Ilacqua, Vito
Project Period: June 1, 2011 through May 31, 2014 (Extended to May 31, 2015)
Project Amount: $298,857
RFA: Exploring New Air Pollution Health Effects Links in Existing Datasets (2010) RFA Text |  Recipients Lists
Research Category: Air Quality and Air Toxics , Health Effects , Air


We further tested the hypothesis that clinical autoimmune disease presentation and exacerbation are associated with exposures to short-term pollution, including PM2.5. In Objective 1, we further established associations between short-term PM2.5 exposure and the clinical onset of Systemic Onset Juvenile Idiopathic Arthritis, a subtype of JIA. In Objective 2, we tested for associations between short-term ambient PM2.5 and the clinical onset of Kawasaki Disease. In Objective 3, we tested for associations between short-term PM2.5 and clinical disease activity of Henoch Schonlein Purpura. Cases came from various geographic metropolitan regions of the United States and Canada (Toronto). 

Summary/Accomplishments (Outputs/Outcomes):

  • We completed the process of subject data transfer from all collaborating centers, and collected usable case data sets for our analysis.
  • We assembled PM2.5 exposure measurements from monitors and carefully imputed PM2.5 to provide day-to-day temporal variability and resolution for reliable time series indexes of pollution exposures for each metropolitan area (Philadelphia, Boston, Toronto, Chicago, Atlanta, Cincinnati, San Diego, Salt Lake City, Denver and Cleveland).
  • We completed the case-crossover analysis and interpretation of results from all three study research objectives.


  • Our multi-city case crossover study in systemic onset Juvenile Idiopathic Arthritis (Objective 1) has yielded results that essentially reproduce those we have previously published, further suggesting that short-term exposure to ambient fine particulate matter (PM2.5) is a risk factor in the development and clinical presentation of systemic onset Juvenile Idiopathic Arthritis in young preschool aged children. These findings were presented at The American College of Rheumatology Annual Meeting in November 2014. Our manuscript representing this work went to final editorial review after resubmission to the journal, Arthritis & Rheumatology (impact factor 7.8). We have resubmitted the paper to the journal, Clinical and Experimental Rheumatology.
  • Our multi-city case crossover studies in Kawasaki Disease (Objective 2) yielded results, which did not establish a risk of the event dates of Kawasaki Disease clinical onset. We presented results at the 2015 European Workshop for Rheumatology Research (EWRR), March 5-7, 2015, Budapest, Hungary. This manuscript is being submitted to the well respected journal, The Journal of Pediatrics.
  • Our multi-city case crossover studies in Henoch Schonlein Purpura (Objective 3) yielded results, which did not establish a risk of hospitalization for exacerbation of pediatric HSP with short-term ambient particulate pollution exposure. We presented these results at the 2014 Midwest Society of Pediatric Research.

Journal Articles on this Report : 2 Displayed | Download in RIS Format

Other project views: All 10 publications 2 publications in selected types All 2 journal articles
Type Citation Project Document Sources
Journal Article Zeft AS, Burns JC, Yeung RS, McCrindle BW, Newburger JW, Dominguez SR, Anderson MS, Arrington C, Shulman ST, Yoon J, Tewelde H, Mix C, Pope CA. Kawasaki Disease and exposure to fine particulate air pollution. The Journal of Pediatrics 2016;177:179-183.e1. R834992 (Final)
  • Abstract from PubMed
  • Full-text: ScienceDirect-Full Text HTML
  • Abstract: ScienceDirect-Abstract
  • Other: ScienceDirect-Full Text PDF
  • Journal Article Zeft AS, Prahalad S, Schneider R, Dedeoglu F, Weiss PF, Grom AA, Mix C, Pope CA. Systemic onset juvenile idiopathic arthritis and exposure to fine particulate air pollution. Clinical and Experimental Rheumatology 2016;34(5):946-952. R834992 (Final)
  • Abstract from PubMed
  • Abstract: CER-Abstract
  • Supplemental Keywords:

    Urban air quality, climate, personal exposure, health risks, air toxics, air quality, ambient particle properties, atmospheric monitoring, cumulative exposure, children's health

    Progress and Final Reports:

    Original Abstract
  • 2011 Progress Report
  • 2012 Progress Report
  • 2013 Progress Report