External exposome and incident asthma across the life course in 14 European cohorts: the EXPANSE project

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Background: The joint impact of multiple urban environmental factors on asthma remains unclear. Methods: We analyzed data from 14 European cohorts to assess urban exposome’s impact on asthma incidence across the life course. We linked three external exposome domains (air pollution, built environment, ambient temperature) to the participants’ home addresses at baseline. We performed k-means clustering within each domain and assessed associations of clusters with asthma adjusting for relevant covariates in cohort-specific analysis, with subsequent meta-analysis. An environmental risk score (ERS) combining all domains was calculated using a coefficient-weighted sum approach. Results: A total of 7,428 incident asthma cases were identified among 348,937 participants (birth to age 70s). We observed higher risks of asthma for clusters with high particulate matter-nitrogen dioxide exposure (ORmeta=1.18, 95%CI: 0.97-1.42 for birth cohorts and ORmeta=1.13, 95%CI:1.01-1.25 for adult cohorts), and clusters with high built-up area and low levels of greenness (ORmeta=1.36, 95%CI: 1.14-1.64 for birth cohorts and ORmeta=1.15, 95%CI: 1.03-1.28 for adult cohorts, respectively). ERS combining three domains was consistently associated with higher risk of incident asthma (ORmeta=1.16, 95%CI: 1.11-1.22 for birth cohorts, ORmeta=1.13, 95%CI: 1.08-1.18 for adult cohorts per standard deviation increase). Reducing ERS to below cohort-specific median levels could avert around 10% of cases. Conclusions: Multiple environmental exposures jointly contribute to incident asthma risk across the life course. Urban planning accounting for these factors may help mitigating asthma development.

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