Lee Yung-Ling, Lin Ying-Chu, Hsiue Tzuen-Ren, Hwang Bing-Fang, Guo Yueliang Leon
Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Pediatrics. 2003 Nov;112(5):e389. doi: 10.1542/peds.112.5.e389.
Parental atopy and environmental exposures are recognized risk factors for childhood asthma. However, the relative contributions of specific risk factors and the overall contributions of indoor and outdoor exposures remain unexplored. This study was undertaken to identify risk factors, estimate the population attributable risk of each exposure, and compare the data for boys versus girls for physician-diagnosed asthma in Taiwanese schoolchildren.
During a February to June 2001 cross-sectional national survey, 35 036 6- to 15-year-old schoolchildren were chosen from 22 elementary and 22 middle schools located within 1-km catchment areas of 22 air-monitoring stations in Taiwan. The main outcome measure was physician-diagnosed asthma, as reported by the parents. We investigated hereditary and indoor and outdoor environmental factors for childhood asthma by questionnaire. The adjusted prevalences of questionnaire-determined outdoor indicators were also compared with air-monitoring data.
Outdoor air pollutants were associated with parent-reported perceived ambient air pollution. Physician-diagnosed asthma was reported for 8.1% of the boys (1330 of 16 441) and 5.6% of the girls (894 of 16 056). The risk of physician-diagnosed asthma was significantly associated with parental atopy and perceived ambient air pollution in both sexes. The presence of visible cockroaches (odds ratio [OR]: 1.30; 95% confidence interval [CI]: 1.07-1.59), mold on walls at home (OR: 1.20; 95% CI: 1.01-1.41), and water damage (OR: 1.33; 95% CI: 1.02-1.70) were also associated with asthma in girls; however, only visible mold on walls at home was related to asthma in boys. Mutually adjusted analytical models produced statistically significant associations between any indoor factor and asthma in girls (OR: 1.24; 95% CI: 1.00-1.56) but not in boys (OR: 1.04; 95% CI: 0.87-1.25). For all hereditary and environmental factors, the total population attributable risk was 44.31% in boys and 60.61% in girls.
Parental atopy contributed more to childhood asthma than indoor or outdoor environmental factors. Girls may be more susceptible to indoor factors than boys.
父母患特应性疾病和环境暴露是儿童哮喘公认的风险因素。然而，特定风险因素的相对贡献以及室内和室外暴露的总体贡献仍未得到充分研究。本研究旨在确定风险因素，估计每种暴露因素的人群归因风险，并比较台湾学龄儿童中经医生诊断的哮喘在男孩和女孩中的相关数据。
在2001年2月至6月的全国横断面调查中，从台湾22个空气监测站1公里集水区内的22所小学和22所中学中选取了35036名6至15岁的学龄儿童。主要结局指标是父母报告的经医生诊断的哮喘。我们通过问卷调查研究了儿童哮喘的遗传因素以及室内和室外环境因素。还将问卷调查确定的室外指标的校正患病率与空气监测数据进行了比较。
室外空气污染物与父母报告的感知环境空气污染有关。报告经医生诊断患有哮喘的男孩占8.1%（16441名中的1330名），女孩占5.6%（16056名中的894名）。经医生诊断的哮喘风险在两性中均与父母患特应性疾病和感知环境空气污染显著相关。家中可见蟑螂（比值比[OR]：1.30；95%置信区间[CI]：1.07 - 1.59）、家中墙壁上有霉菌（OR：1.20；95% CI：1.01 - 1.41）以及水浸损坏（OR：1.33；95% CI：1.02 - 1.70）也与女孩哮喘相关；然而，只有家中墙壁上可见的霉菌与男孩哮喘有关。相互校正的分析模型显示，任何室内因素与女孩哮喘之间存在统计学显著关联（OR：1.24；95% CI：1.00 - 1.56），但与男孩哮喘无关联（OR：1.04；95% CI：0.87 - 1.25）。对于所有遗传和环境因素，男孩的总人群归因风险为44.31%，女孩为60.61%。
父母患特应性疾病对儿童哮喘的影响大于室内或室外环境因素。女孩可能比男孩更容易受到室内因素的影响。
