{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T12:11:29Z","timestamp":1785413489385,"version":"3.56.0"},"reference-count":36,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007511","name":"Universidad Rey Juan Carlos","doi-asserted-by":"publisher","award":["2024\/SOLCON-134827"],"award-info":[{"award-number":["2024\/SOLCON-134827"]}],"id":[{"id":"10.13039\/501100007511","id-type":"DOI","asserted-by":"publisher"}]},{"award":["2024\/SOLCON-134827"],"award-info":[{"award-number":["2024\/SOLCON-134827"]}],"id":[{"id":"https:\/\/ror.org\/01v5cv687","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Epidemiologia"],"abstract":"<jats:p>Background\/Objectives: Asthma-coded hospital admissions in very young children represent a clinically relevant but diagnostically complex marker of severe wheezing\/asthma-like morbidity. Methods: We conducted a nationwide ecological municipality-year study of children aged 0\u20133 years in Spain during 2020\u20132022 using hospital discharge records from the Spanish Minimum Basic Data Set (MBDS\/RAE-CMBD). Exposure and outcome were analyzed at the municipality-year level: the exposure metric was the contemporaneous annual mean municipality-level concentration of PM2.5, PM10, NO2, SO2, O3, and CO, and the outcome was the annual number of asthma-coded admissions, with the population aged 0\u20133 years as offset. Results: The regression panel comprised 20,746 municipality-year observations, 7251 municipalities, and 3231 admissions; 93.7% of municipality-years had zero admissions. In unipollutant Poisson models adjusted for calendar year, rural\u2013urban status, temperature, and relative humidity, incidence rate ratios per interquartile-range increase were 1.54 (95% CI 1.28\u20131.85) for PM2.5 and 1.89 (95% CI 1.59\u20132.26) for PM10. Negative-binomial and province-fixed-effect sensitivity models attenuated but did not remove the particulate-matter signal. The multipollutant model was unstable because of strong collinearity between particulate fractions and was interpreted only as an exploratory sensitivity analysis. Conclusions: These findings should be interpreted as ecological, population-level associations between annual ambient particulate pollution and pediatric respiratory hospital burden, not as individual-level causal risk estimates.<\/jats:p>","DOI":"10.3390\/epidemiologia7040097","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T16:16:44Z","timestamp":1783613804000},"page":"97","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ambient Air Pollution and Asthma-Coded Hospital Admission Rates in Children Aged 0\u20133 Years in Spain: A Municipality-Year Urban\u2013Rural Ecological Study"],"prefix":"10.3390","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6929-8453","authenticated-orcid":false,"given":"Laura","family":"S\u00e1nchez de Prada","sequence":"first","affiliation":[{"name":"Departamento de Medicina, Facultad de Medicina, Universidad de Valladolid, 47003 Valladolid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3760-2550","authenticated-orcid":false,"given":"Daniel","family":"V\u00e9lez-Serrano","sequence":"additional","affiliation":[{"name":"Departamento de Estad\u00edstica e Investigaci\u00f3n Operativa, Facultad de Matem\u00e1ticas, Universidad Complutense de Madrid, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1315-4386","authenticated-orcid":false,"given":"Alejandro","family":"Alvaro-Meca","sequence":"additional","affiliation":[{"name":"Departamento de Medicina Preventiva y Salud P\u00fablica, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, 28922 Alcorc\u00f3n, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1016\/S0140-6736(20)30925-9","article-title":"Global burden of 369 diseases and injuries in 204 countries and territories, 1990\u20132019: A systematic analysis for the Global Burden of Disease Study 2019","volume":"396","author":"Vos","year":"2020","journal-title":"Lancet"},{"key":"ref_2","unstructured":"Global Burden of Disease Collaborative Network (2025). Global Burden of Disease Study 2023 (GBD 2023) Findings, Institute for Health Metrics and Evaluation (IHME). Technical Report."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"To, T., Stanojevic, S., Moores, G., Gershon, A.S., Bateman, E.D., Cruz, A.A., and Boulet, L.P. (2012). Global asthma prevalence in adults: Findings from the cross-sectional world health survey. BMC Public Health, 12.","DOI":"10.1186\/1471-2458-12-204"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2226","DOI":"10.1056\/NEJMra054308","article-title":"The Asthma Epidemic","volume":"355","author":"Eder","year":"2006","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.1016\/S0140-6736(14)60617-6","article-title":"Outdoor air pollution and asthma","volume":"383","author":"Guarnieri","year":"2014","journal-title":"Lancet"},{"key":"ref_6","unstructured":"U.S. Environmental Protection Agency (2019). Integrated Science Assessment for Particulate Matter (December 2019), U.S. EPA. Technical Report, EPA\/600\/R-19\/188."},{"key":"ref_7","unstructured":"World Health Organization (2025, March 11). WHO Global Air Quality Guidelines: Particulate Matter (PM25 and PM10), Ozone, Nitrogen Dioxide, Sulfur Dioxide and Carbon Monoxide. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240034228."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1164\/rccm.201810-1823OC","article-title":"Short-Term Exposure to Ambient Air Pollution and Asthma Mortality","volume":"200","author":"Liu","year":"2019","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1097\/01.ede.0000181308.51440.75","article-title":"Childhood asthma and exposure to traffic and nitrogen dioxide","volume":"16","author":"Gauderman","year":"2005","journal-title":"Epidemiology"},{"key":"ref_10","unstructured":"Hashemi, A., Shirkani, A., Hashemi, M., Salimi, M.D., Be-Hzadi, S., Fakharian, A., and Farrokhi, S. (2017). Role of Air Pollution on Pathogenesis of Asthma and Allergic Diseases, Tehran University of Medical Sciences (TUMS) Journals Publishing House. Technical Report."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jaci.2021.05.006","article-title":"Air pollution and lung function in children","volume":"148","author":"Garcia","year":"2021","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1346","DOI":"10.1016\/j.chest.2020.10.053","article-title":"Air Pollution and Asthma: Mechanisms of Harm and Considerations for Clinical Interventions","volume":"159","author":"Pfeffer","year":"2021","journal-title":"Chest"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1007\/s11882-022-01034-1","article-title":"Emerging Insights into the Impact of Air Pollution on Immune-Mediated Asthma Pathogenesis","volume":"22","author":"Tuazon","year":"2022","journal-title":"Curr. Allergy Asthma Rep."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"110468","DOI":"10.1016\/j.envres.2020.110468","article-title":"Air pollution from traffic during pregnancy impairs newborn\u2019s cord blood immune cells: The NELA cohort","volume":"198","year":"2021","journal-title":"Environ. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e240535","DOI":"10.1001\/jamanetworkopen.2024.0535","article-title":"Early-Life Exposure to Air Pollution and Childhood Asthma Cumulative Incidence in the ECHO CREW Consortium","volume":"7","author":"Zanobetti","year":"2024","journal-title":"JAMA Netw. Open"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.1016\/j.jaip.2026.01.043","article-title":"Lung Function Decline in Asthma: Mechanisms, Risk Factors, and Clinical Implications for Personalized Management","volume":"14","author":"Portacci","year":"2026","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_17","unstructured":"Global Initiative for Asthma (2026, April 24). Global Strategy for Asthma Management and Prevention, 2024 Update. Available online: https:\/\/ginasthma.org\/2024-report\/."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.envint.2016.11.012","article-title":"Exposure to traffic-related air pollution and risk of development of childhood asthma: A systematic review and meta-analysis","volume":"100","author":"Khreis","year":"2017","journal-title":"Environ. Int."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1802194","DOI":"10.1183\/13993003.02194-2018","article-title":"Outdoor air pollution and the burden of childhood asthma across Europe","volume":"54","author":"Khreis","year":"2019","journal-title":"Eur. Respir. J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3766","DOI":"10.1289\/EHP3766","article-title":"Estimates of the Global Burden of Ambient PM2.5, Ozone, and NO2 on Asthma Incidence and Emergency Room Visits","volume":"126","author":"Anenberg","year":"2018","journal-title":"Environ. Health Perspect."},{"key":"ref_21","unstructured":"Subdirecci\u00f3n General de Informaci\u00f3n Sanitaria e Innovaci\u00f3n (2022, July 18). Registro de Actividad de Atenci\u00f3n Especializada RAE-CMBD. Available online: https:\/\/www.sanidad.gob.es\/estadEstudios\/estadisticas\/cmbdhome.htm."},{"key":"ref_22","unstructured":"Spanish Ministry of Health (2026, June 15). Registro de Actividad de Atenci\u00f3n Especializada. RAE-CMBD: Solicitud de Extracci\u00f3n de Datos. Available online: https:\/\/www.sanidad.gob.es\/estadEstudios\/estadisticas\/estadisticas\/estMinisterio\/SolicitudCMBD.htm."},{"key":"ref_23","unstructured":"ICD-10-CM (2022, July 18). Diagnosis Codes. Available online: www.icd10data.com."},{"key":"ref_24","unstructured":"European Parliament and Council of the European Union (2026, June 15). Regulation (EU) 2016\/679 of the European Parliament and of the Council of 27 April 2016 (General Data Protection Regulation), Recital 26. Official Journal of the European Union. Available online: https:\/\/eur-lex.europa.eu\/eli\/reg\/2016\/679\/oj."},{"key":"ref_25","unstructured":"Agencia Espa\u00f1ola de Protecci\u00f3n de Datos (2026, June 15). \u00bfLos Datos Anonimizados son Datos Personales?. Available online: https:\/\/www.aepd.es\/preguntas-frecuentes\/0-conceptos-basicos\/FAQ-0005-sobre-los-datos-anonimizados."},{"key":"ref_26","unstructured":"Jefatura del Estado (2026, June 15). Ley Org\u00e1nica 3\/2018, de 5 de Diciembre, de Protecci\u00f3n de Datos Personales y Garant\u00eda de los Derechos Digitales. Bolet\u00edn Oficial del Estado, BOE-A-2018-16673. Available online: https:\/\/www.boe.es\/buscar\/act.php?id=BOE-A-2018-16673."},{"key":"ref_27","unstructured":"Instituto Nacional de Estad\u00edstica (2024). Cifras Oficiales de Poblaci\u00f3n de los Municipios Espa\u00f1oles: Revisi\u00f3n del Padr\u00f3n Municipal, Instituto Nacional de Estad\u00edstica (INE)."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Donzelli, G., Cioni, L., Cancellieri, M., Llopis-Morales, A., and Morales-Su\u00e1rez-Varela, M. (2021). Relations between Air Quality and COVID-19 Lockdown Measures in Valencia, Spain. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18052296"},{"key":"ref_29","first-page":"5","article-title":"Estimaciones de la poblaci\u00f3n rural y urbana a nivel municipal","volume":"57","year":"2015","journal-title":"Estad. Esp."},{"key":"ref_30","unstructured":"Copernicus Atmosphere Monitoring Service (CAMS) (2026, March 11). CAMS European Air Quality Forecasts, ENSEMBLE Data. Copernicus Atmosphere Monitoring Service (CAMS) Atmosphere Data Store (ADS). Available online: https:\/\/ads.atmosphere.copernicus.eu\/datasets\/cams-europe-air-quality-reanalyses."},{"key":"ref_31","unstructured":"Mu\u00f1oz Sabater, J. (2025, March 11). ERA5-Land Hourly Data from 1950 to Present. Copernicus Climate Change Service (C3S) Climate Data Store (CDS). Available online: https:\/\/cds.climate.copernicus.eu\/datasets\/reanalysis-era5-land?tab=overview."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1175\/1520-0450(1996)035<0601:IMFAOS>2.0.CO;2","article-title":"Improved Magnus Form Approximation of Saturation Vapor Pressure","volume":"35","author":"Alduchov","year":"1996","journal-title":"J. Appl. Meteorol. Climatol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"106771","DOI":"10.1016\/j.envsoft.2025.106771","article-title":"Adaptive Graph Neural Network\u2013Transformer model for high-resolution PM2.5 forecasting and spatial extrapolation","volume":"196","year":"2026","journal-title":"Environ. Model. Softw."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1007\/s11356-015-5321-x","article-title":"The impact of PM2.5 on asthma emergency department visits: A systematic review and meta-analysis","volume":"23","author":"Fan","year":"2016","journal-title":"Environ. Sci. Pollut. Res."},{"key":"ref_35","unstructured":"European Commission (2026, April 24). New Pollution Rules Come into Effect for Cleaner Air by 2030. Available online: https:\/\/environment.ec.europa.eu\/news\/new-pollution-rules-come-effect-cleaner-air-2030-2024-12-10_en."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1016\/j.jacig.2022.06.001","article-title":"Age-dependent rebound in asthma exacerbations after COVID-19 lockdown","volume":"1","author":"Hazan","year":"2022","journal-title":"J. Allergy Clin. Immunol. Glob."}],"container-title":["Epidemiologia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2673-3986\/7\/4\/97\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T03:16:05Z","timestamp":1783998965000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2673-3986\/7\/4\/97"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,9]]},"references-count":36,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["epidemiologia7040097"],"URL":"https:\/\/doi.org\/10.3390\/epidemiologia7040097","relation":{},"ISSN":["2673-3986"],"issn-type":[{"value":"2673-3986","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,9]]}}}