Abstract
Background
Climate and air pollution are associated with pediatric allergic diseases; however, their relative impacts remain poorly understood, particularly in subtropical climates. This study quantified and compared the contributions of meteorological variables and air pollutants to childhood allergic rhinitis (AR), asthma and atopic dermatitis (AD).Methods
We analyzed 1,516,996 pediatric hospital visits in Chongqing, China (2014-2019, 2023-2024), including AR (n = 456,807), asthma (n = 775,181), and AD (n = 285,008). Using distributed lag non-linear models, we examined associations with temperature, humidity, atmospheric pressure, wind speed, PM₂.₅, PM₁₀, NO₂, SO₂, CO, and O₃, comparing effect magnitudes through standardized coefficients and attributable disease burdens.Results
Temperature demonstrated the strongest associations across all diseases, with opposing effects: positive associations with respiratory allergies (AR: RR = 1.25, 95% CI: 1.16-1.35 at 30 °C, attributing 84,640 cases [18.5% of total burden]; asthma: RR = 1.10, 95% CI: 1.05-1.16 at 32 °C, attributing 58,058 cases [7.5%]) versus inverse association with AD (RR = 0.75, 95% CI: 0.68-0.83 at 30 °C, associated with 58,270 fewer cases [20.4% reduction]). Seasonal analyses demonstrated marked heterogeneity: summer concentrated AR burden (temperature attributing 18,896 cases, 22.3% of annual burden), while winter concentrated asthma NO₂ effects (21,558 cases, 11.1% of winter burden). Individual air pollutants showed substantially smaller effects than temperature.Conclusions
Temperature demonstrated stronger short-term associations with childhood allergic disease burden than individual air pollutants in subtropical settings. Disease-specific environmental susceptibility patterns (opposing temperature effects for respiratory versus dermatological allergies) necessitate tailored prevention strategies. These results support integrating climate adaptation measures alongside air quality management in pediatric environmental health policies, with season-specific interventions during high-burden periods.