Childhood intermittent and persistent rhinitis prevalence and climate and vegetation: A global ecologic analysis

Background: The effect of climate change and its effects on vegetation growth, and consequently on rhinitis,are uncertain.Objective: To examine between- and within-country associations of climate measures and the normalizeddifference vegetation index with intermittent and persistent rhinitis symptoms in a global context.Methods: Questionnaire data from 6- to 7-year-olds and 13- to 14-year-olds were collected in phase 3 of theInternational Study of Asthma and Allergies in Childhood. Associations of intermittent (>1 symptom reportbut not for 2 consecutive months) and persistent (symptoms for -2 consecutive months) rhinitis symptomprevalences with temperature, precipitation, vapor pressure, and the normalized difference vegetation indexwere assessed in linear mixed-effects regression models adjusted for gross national income and populationdensity. The mean difference in prevalence per 100 children (with 95% confidence intervals [CIs]) perinterquartile range increase of exposure is reported.Results: The country-level intermittent symptom prevalence was associated with several country-levelclimatic measures, including the country-level mean monthly temperature (6.09-C; 95% CI, 2.06e10.11-C per 10.4-C), precipitation (3.10 mm; 95% CI, 0.46e5.73 mm; per 67.0 mm), and vapor pressure(6.21 hPa; 95% CI, 2.17e10.24 hPa; per 10.4 hPa) among 13- to 14-year-olds (222 center in 94 countries).The center-level persistent symptom prevalence was positively associated with several center-level climaticmeasures. Associations with climate were also found for the 6- to 7-year-olds (132 center in 57countries).Conclusion: Several between- and within-country spatial associations between climatic factors and intermittentand persistent rhinitis symptom prevalences were observed. These results provide suggestive evidencethat climate (and future changes in climate) may influence rhinitis symptom prevalence.