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Michael Brauer,¹ Ulrike Gehring,² Bert Brunekreef,³ Johan de Jongste,⁴ Jorrit Gerritsen,⁵ Maroeska Rovers,⁶ Heinz-Erich Wichmann,² Alet Wijga,⁷ and Joachim Heinrich²

¹University of British Columbia, School of Occupational and Environmental Hygiene, Vancouver, British Columbia, Canada; ²GSF–National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg, Germany; ³Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; ⁴Department of Pediatrics, Division of Respiratory Medicine, Erasmus Medical Center–Sophia Children's Hospital, Erasmus University, Rotterdam, the Netherlands; ⁵Department of Pediatric Respiratory Medicine, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands; ⁶Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, the Netherlands; ⁷Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands

Abstract
Background: Otitis media is one of the most common infections in young children. Although exposure to environmental tobacco smoke is a known risk factor associated with otitis media, little information is available regarding the potential association with air pollution.

Objective: We set out to study the relationship between exposure to traffic-related air pollution and otitis media in two birth cohorts.

Methods: Individual estimates of outdoor concentrations of traffic-related air pollutants—nitrogen dioxide, fine particles [particulate matter with aerodynamic diameters ≤ 2.5 µm (PM_2.5) ], and elemental carbon—were calculated for home addresses of approximately 3,700 and 650 infants from birth cohort studies in the Netherlands and Germany, respectively. Air pollution exposure was analyzed in relation to physician diagnosis of otitis media in the first 2 years of life.

Results: Odds ratios (adjusted for known major risk factors) for otitis media indicated positive associations with traffic-related air pollutants. An increase in 3 µg/m³ PM_2.5, 0.5 µg/m³ elemental carbon, and 10 µg/m³ NO₂ was associated with odds ratios of 1.13 (95% confidence interval, 1.00–1.27) , 1.10 (1.00–1.22) , and 1.14 (1.03–1.27) in the Netherlands and 1.24 (0.84–1.83) , 1.10 (0.86–1.41) , and 1.14 (0.87–1.49) in Germany, respectively.

Conclusions: These findings indicate an association between exposure to traffic-related air pollutants and the incidence of otitis media. Given the ubiquitous nature of air pollution exposure and the importance of otitis media to children's health, these findings have significant public health implications.

Key words: air pollution, cohort studies, infant, otitis media, vehicle emissions. Environ Health Perspect 114: 1414–1418 (2006) . doi:10.1289/ehp.9089 available via http://dx.doi.org/ [Online 26 April 2006]

Address correspondence to M. Brauer, School of Occupational and Environmental Hygiene, University of British Columbia, 3rd Floor, 2206 East Mall, Vancouver BC V6T1Z3 Canada. Telephone (604) 822-9585. Fax: (604) 822-9588. E-mail: brauer@interchange.ubc.ca

We thank K. Meliefste, J. Cyrys, C. Harmath, M. Zeiler, K. Koschine, and M. Pitz for air pollution sampling and measurement, P. van Vliet for preparation of GIS data in the Netherlands, and G. Sedlmair from Stadt München, Referat für Umwelt und Gesundheit, for providing GIS data for Munich.

This study was supported by European Union Environment contracts ENV4 CT97-0506 and QLRT 2000-00073 (exposure modeling) ; by Federal Ministry for Education, Science, Research and Technology grants 01EG 9732 and 01EG 9705/2 (LISA-Munich cohort) ; and by the Netherlands Asthma Fund (94.27) , the Ministry of the Environment, ZorgOnderzoek Nederland, and the national Institute of Public Health and the Environment (PIAMA cohort) . M.B. was supported in part by funding from the Michael Smith Foundation for Health Research to the Centre for Health and Environment Research at the University of British Columbia. U.G. was supported by a research fellowship within the Postdoc-Programme of the German Academic Exchange Service (DAAD) .

The authors declare they have no competing financial interests.

Received 13 February 2006 ; accepted 26 April 2006.