Homøe P, Christensen R B, Bretlau P
Department of Otolaryngology, Head & Neck Surgery, Rigshospitalet, University of Copenhagen, Denmark.
Int J Pediatr Otorhinolaryngol. 1999 Jun 15;49(1):37-52. doi: 10.1016/s0165-5876(99)00044-0.
To describe the sociomedical risk factors associated with episodes of acute otitis media (AOM), recurrent AOM (rAOM), and chronic otitis media (COM) in Greenlandic children and especially to point out children at high risk of rAOM (defined as > 5 AOM episodes since birth) and COM which are prevalent among Inuit children all over the Arctic.
The study design was cross-sectional and included 740 unselected children, 3, 4, 5, and 8-years-old, living in two major Greenlandic towns, Nuuk and Sisimiut. All children were otologically examined and the parents answered a questionnaire containing sociomedical variables including ethnicity, family history of OM, housing, insulation, crowding, daycare, passive cigarette smoking, breast feeding, type of diet, allergy, and chronic diseases. Historical data were cross-checked in medical records which also formed the basis for the drop-out analyses. Statistical analyses included frequency tests, calculation of odds ratio (OR), and multiple logistic regression.
The attendance rate was 86%. Former episode of AOM was reported by 2/3 of the children, rAOM by 20%, and COM by 9%. The following variables were found significantly more often in children with AOM by simple frequency testing: Parental (OR = 1.83), sibling (OR = 1.62), and parental plus sibling (OR = 2.56) history of OM, crowding (OR = 5.55), long period of exclusive breast feeding ( > 4 months) (OR = 2.47), and recent acute disease (P = 0.034). The following variables were found significantly more often in children with rAOM or COM by simple frequency testing: Parental history of OM (OR = 1.60; OR = 2.11, respectively) and no recall of breast feeding (P = 0.005; P = 0.003, respectively). Also, COM was found significantly more often in children with two Greenlandic parents (OR = 3.07). A multiple logistic regression test denoted only parental history of OM (OR = 1.82) and long period of exclusive breast feeding (OR = 1.14) as significant predictors of AOM.
Many of the risk factors usually associated with AOM could not be confirmed as risk factors in this survey. Parental history of OM and long period of exclusive breast feeding were the strongest factors associated with AOM in Greenlandic children and ethnicity was associated with COM. However, the study confirms that AOM is a multifactorial disease determined by a number of genetic and environmental factors.
描述与格陵兰儿童急性中耳炎（AOM）、复发性急性中耳炎（rAOM）及慢性中耳炎（COM）发作相关的社会医学风险因素，尤其指出rAOM（定义为自出生以来AOM发作>5次）及COM的高危儿童，这些疾病在北极地区的因纽特儿童中普遍存在。
本研究为横断面研究，纳入了居住在格陵兰两个主要城镇努克和西西缪特的740名3岁、4岁、5岁和8岁未经过筛选的儿童。对所有儿童进行了耳科检查，家长回答了一份包含社会医学变量的问卷，这些变量包括种族、中耳炎家族史、住房、隔热、拥挤程度、日托、被动吸烟、母乳喂养、饮食类型、过敏及慢性病。历史数据在病历中进行了交叉核对，病历也构成了失访分析的基础。统计分析包括频率检验、比值比（OR）计算及多因素逻辑回归。
参与率为86%。2/3的儿童报告有AOM既往发作史，20%有rAOM既往发作史，9%有COM既往发作史。通过简单频率检验发现，以下变量在AOM儿童中出现的频率显著更高：父母（OR = 1.83）、兄弟姐妹（OR = 1.62）及父母加兄弟姐妹（OR = 2.56）的中耳炎病史、拥挤（OR = 5.55）、长时间纯母乳喂养（>4个月）（OR = 2.47）及近期急性疾病（P = 0.034）。通过简单频率检验发现，以下变量在rAOM或COM儿童中出现的频率显著更高：父母的中耳炎病史（分别为OR = 1.60；OR = 2.11）及不记得母乳喂养情况（分别为P = 0.005；P = 0.003）。此外，在父母均为格陵兰人的儿童中，COM的发生率显著更高（OR = 3.07）。多因素逻辑回归检验仅表明父母的中耳炎病史（OR = 1.82）及长时间纯母乳喂养（OR = 1.14）是AOM的显著预测因素。
在本次调查中，许多通常与AOM相关的风险因素未被确认为风险因素。父母的中耳炎病史及长时间纯母乳喂养是与格陵兰儿童AOM相关的最强因素，种族与COM相关。然而，该研究证实AOM是一种由多种遗传和环境因素决定的多因素疾病。
