{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T15:05:52Z","timestamp":1779548752051,"version":"3.53.1"},"posted":{"date-parts":[[2026,5,21]]},"group-title":"Epidemiology","reference-count":50,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,5,21]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>\n                    Nitrogen dioxide (NO\n                    <jats:sub>2<\/jats:sub>\n                    ) is a surrogate for traffic and industrial air pollution associated with adverse respiratory outcomes. Whether elevated NO\n                    <jats:sub>2<\/jats:sub>\n                    and temperature jointly influence adult-onset asthma (AOA) risk is unclear, especially among subgroups with varying lifestyle and exposure profiles. We investigated further in the prospective All of Us research program.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>\n                    Among 596,926 U.S. participants who consented to electronic health record release, annual average NO\n                    <jats:sub>2<\/jats:sub>\n                    concentrations from satellite data were linked to residential locations for 376,535 individuals. We used multivariable Cox regression to estimate associations between NO\n                    <jats:sub>2<\/jats:sub>\n                    , temperature, and incident AOA, adjusting for co-pollutants and potential confounders. We analyzed 4-category cross-classification variables between NO\n                    <jats:sub>2<\/jats:sub>\n                    (\u201chigh\u201d&gt;75\n                    <jats:sup>th<\/jats:sup>\n                    percentile vs. \u201clow\u201d \u226475\n                    <jats:sup>th<\/jats:sup>\n                    percentile) and maximum or average temperature (\u201chigh\u201d&gt;median vs. \u201clow\u201d\u2264median). We also stratified by sex, age, income, and smoking status. Additive interactions were estimated using Relative Excess Risk due to Interaction, Attributable Proportion, and Synergy Index.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>\n                    We identified 10,413 incident AOA cases over an average 4-year follow-up. Participants with the highest categories of NO\n                    <jats:sub>2<\/jats:sub>\n                    and temperature exposure had significantly higher risk compared to those with the lowest (HR\n                    <jats:sub>High<\/jats:sub>\n                    <jats:sub>NO2\u00d7High<\/jats:sub>\n                    <jats:sub>Max.<\/jats:sub>\n                    <jats:sub>Temp.<\/jats:sub>\n                    =1.37, 95%CI:1.26-1.49; HR\n                    <jats:sub>High<\/jats:sub>\n                    <jats:sub>NO2\u00d7High<\/jats:sub>\n                    <jats:sub>Average<\/jats:sub>\n                    <jats:sub>Temp.<\/jats:sub>\n                    =1.49, 95%CI:1.38-1.61). The joint association of high NO\n                    <jats:sub>2<\/jats:sub>\n                    and high maximum temperature was more pronounced among ever-smokers (HR=1.59, 95%CI:1.40-1.81) than never-smokers (HR=1.26, 95%CI:1.13-1.41). Interaction analyses supported super-additive interactions of high NO\n                    <jats:sub>2<\/jats:sub>\n                    and high average temperature on AOA risk, particularly among ever smokers, lower-income participants, and younger adults.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Our findings highlight the respiratory health threat of long-term joint exposure to elevated NO\u2082 and average temperature, particularly among vulnerable subgroups.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.05.15.26353311","type":"posted-content","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:13Z","timestamp":1779408013000},"source":"Crossref","is-referenced-by-count":0,"title":["Joint Associations of Outdoor Nitrogen Dioxide and Temperature with Incident Adult-Onset Asthma in the United 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