{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T06:51:47Z","timestamp":1781679107730,"version":"3.54.5"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Short-term exposure to ambient air pollution has been associated with Kawasaki disease (KD), however, evidence from cold climates remains limited. We aim to evaluate the association between short-term ambient pollutant exposure and KD onset in a cold region of China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted an ecological time-series study based on aggregated daily counts of hospital-diagnosed KD onset cases. Individual clinical records from 2,562 hospitalized patients diagnosed with KD at two large tertiary medical centers between January 1, 2015, and December 31, 2022, were used to identify eligible cases and determine the dates of first fever onset. Our analysis included a year-round evaluation of multiple ambient pollutants pertinent to both heating and non-heating periods typical of cold regions. We assessed six pollutants (PM\n                      <jats:sub>2.5<\/jats:sub>\n                      , PM\n                      <jats:sub>10<\/jats:sub>\n                      , SO\u2082, NO\u2082, CO, and O\u2083) using a generalized linear model with distributed lag nonlinear models (GLM\u2013DLNM), and performed stratified analyses of CO and NO\u2082 by gender and heating season.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      High CO concentration (RR\u202f=\u202f1.172; 95% CI: 1.024\u20131.340) and high NO\u2082 concentration (RR\u202f=\u202f1.117; 95% CI: 1.009\u20131.237) were associated with elevated KD risk at lag 0 under single-day lag analysis. Significant cumulative effects were observed for CO (lag 0\u20136: RR 1.838; 95% CI: 1.022\u20133.306) and NO\n                      <jats:sub>2<\/jats:sub>\n                      (lag 0\u20132: RR 1.298; 95% CI: 1.003\u20131.680). Cumulative exposure\u2013response curves indicated that KD risk increased at concentrations above approximately 1.85\u202fmg\/m\n                      <jats:sup>3<\/jats:sup>\n                      for CO and 53.6\u202f\u03bcg\/m\n                      <jats:sup>3<\/jats:sup>\n                      for NO\u2082. In stratified analyses, these associations appeared more evident among females and during the heating season. Furthermore, O\n                      <jats:sub>3<\/jats:sub>\n                      , SO\n                      <jats:sub>2<\/jats:sub>\n                      , PM\n                      <jats:sub>2.5<\/jats:sub>\n                      and PM\n                      <jats:sub>10<\/jats:sub>\n                      showed no significant links.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Short-term exposure to CO and NO\u2082 was associated with increased daily hospital-diagnosed KD onset cases. Reducing CO and NO\n                      <jats:sub>2<\/jats:sub>\n                      may have potential children health relevance, although further studies are needed to confirm these associations and clarify underlying mechanisms.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1853103","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T05:52:37Z","timestamp":1781675557000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Short-term exposure to CO and NO2 and Kawasaki disease onset in a cold region of China: a distributed lag non-linear time-series study"],"prefix":"10.3389","volume":"14","author":[{"given":"Jingchun","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery, the Sixth Affiliated Hospital of Harbin Medical University","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yishan","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, the Sixth Affiliated Hospital of Harbin Medical University","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Food Hygiene, The National Key Discipline, School of Public Health, Harbin Medical University","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuzhu","family":"Chen","sequence":"additional","affiliation":[{"name":"Tianjin Children\u2019s Hospital","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongxin","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, the First Affiliated Hospital of Harbin Medical University","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaqing","family":"Zhang","sequence":"additional","affiliation":[{"name":"Sydney Smart Technology College, Northeastern University","place":["Qinhuangdao, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Cardiology, the First Affiliated Hospital of Harbin Medical University","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuguang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Child Healthcare, Heilongjiang Hospital of Beijing Children's Hospital","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiqiang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, National Children's Medical Center, Beijing Children's Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,17]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1630","DOI":"10.1038\/s41390-025-04302-8","article-title":"The future of Kawasaki disease management: data-driven innovations from bedside to bench and back again","volume":"98","author":"Okada","year":"2025","journal-title":"Pediatr Res"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e481","DOI":"10.1161\/CIR.0000000000001295","article-title":"Update on diagnosis and management of Kawasaki disease: a scientific statement from the American heart association","volume":"150","author":"Jone","year":"2024","journal-title":"Circulation"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e1165","DOI":"10.1161\/CIR.0000000000001234","article-title":"Environmental exposures and pediatric cardiology: a scientific statement from the American heart 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Perspect"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"140828","DOI":"10.1016\/j.chemosphere.2023.140828","article-title":"Short-term exposure to ozone may trigger the onset of Kawasaki disease: An individual-level, case-crossover study in East China","volume":"349","author":"Zhu","year":"2024","journal-title":"Chemosphere"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1038\/s41390-025-04116-8","article-title":"Ozone exposure is positively correlated with the occurrence of Kawasaki disease in Chinese children","volume":"99","author":"ShuHan","year":"2025","journal-title":"Pediatr Res"},{"key":"ref34","first-page":"419","article-title":"Exposure Measurement Error in Time-Series Studies of Air Pollution: Concepts and Consequences","volume-title":"Environmental Health Perspectives","author":"Zeger","year":"2000"}],"container-title":["Frontiers in Public 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