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Estimation of the environmental attributable fraction of asthma among Canadian children: a systematic review


We systematically summarized studies that evaluated the associations between environmental exposures and asthma development by calculating the population attributable fraction (PAF) of Canadian childhood asthma due to modifiable environmental exposures.


Asthma incidence among Canadian children was estimated from population-based surveys and administrative datasets. The prevalence of Canadian exposure to airborne pollutants, environmental tobacco smoke (ETS), indoor allergens, and home mould and moisture were determined from peer-reviewed publications and government reports. International estimates of the relative risk of physician-diagnosed asthma were determined from peer-reviewed studies and used to determine attributable risk (AR) for PAF calculation.


The Canadian childhood asthma incidence was between 2.8% and 5.3%. Canadian exposure prevalences were: PM10 16%, outdoor PM2.5 7.1%, indoor PM2.5 1.7%, outdoor NO2 25%, indoor NO2 3.3%, O3 22%, SO2 0.1%, CO 0.1%, environmental tobacco smoke (ETS) 9.0%, cat 22%, dog 12%, mouse 17%, cockroach 1.7%, dust mite 30%, moisture 14%, and mould 33%. Median odds ratios of physician-diagnosed asthma used to determine the AR were above 1.00 for PM10, PM2.5, NO2, CO, ETS, mouse, cockroach, moisture, and mould. The PAF estimates were: PM10 11%, outdoor PM2.5 1.2%, indoor PM2.5 0.30%, outdoor NO2 1.4%, indoor NO2 0.19%, ETS 4.0%, mouse 3.8%, cockroach 0.22%, moisture 4.5%, mould 10%, and 0 for O3, SO2, CO, cat, dog, and dust mites.


This systematic review suggests contributions to Canadian childhood asthma development from exposure to particulates, NO2, ETS, mouse, cockroach, mould, and moisture, although the results are not consistent enough to imply causation. The associations with cat, dog and dust mite allergen exposure appear to be more complex. These findings highlight the need for longitudinal methods to more accurately estimate the contributions of modifiable environmental exposures to childhood asthma development.

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Correspondence to E Simons.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Simons, E., To, T. & Dell, S. Estimation of the environmental attributable fraction of asthma among Canadian children: a systematic review. All Asth Clin Immun 6, P8 (2010).

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  • Asthma
  • Environmental Tobacco Smoke
  • Attributable Risk
  • Mite Allergen
  • Population Attributable Fraction