Merchant James A, Naleway Allison L, Svendsen Erik R, Kelly Kevin M, Burmeister Leon F, Stromquist Ann M, Taylor Craig D, Thorne Peter S, Reynolds Stephen J, Sanderson Wayne T, Chrischilles Elizabeth A
Department of Occupational and Environmental Health, University of Iowa College of Public Health, Iowa City, Iowa, USA.
Environ Health Perspect. 2005 Mar;113(3):350-6. doi: 10.1289/ehp.7240.
Epidemiologic studies of farm children are of international interest because farm children are less often atopic, have less allergic disease, and often have less asthma than do nonfarm children--findings consistent with the hygiene hypothesis. We studied a cohort of rural Iowa children to determine the association between farm and other environmental risk factors with four asthma outcomes: doctor-diagnosed asthma, doctor-diagnosed asthma/medication for wheeze, current wheeze, and cough with exercise. Doctor-diagnosed asthma prevalence was 12%, but at least one of these four health outcomes was found in more than a third of the cohort. Multivariable models of the four health outcomes found independent associations between male sex (three asthma outcomes), age (three asthma outcomes), a personal history of allergies (four asthma outcomes), family history of allergic disease (two asthma outcomes), premature birth (one asthma outcome), early respiratory infection (three asthma outcomes), high-risk birth (two asthma outcomes), and farm exposure to raising swine and adding antibiotics to feed (two asthma outcomes). The high prevalence of rural childhood asthma and asthma symptoms underscores the need for asthma screening programs and improved asthma diagnosis and treatment. The high prevalence of asthma health outcomes among farm children living on farms that raise swine (44.1%, p = 0.01) and raise swine and add antibiotics to feed (55.8%, p = 0.013), despite lower rates of atopy and personal histories of allergy, suggests the need for awareness and prevention measures and more population-based studies to further assess environmental and genetic determinants of asthma among farm children.
对农场儿童的流行病学研究具有国际意义,因为与非农场儿童相比,农场儿童患特应性疾病的几率更低,患过敏性疾病的情况较少,且患哮喘的情况也往往较少——这些发现与卫生假说相符。我们对爱荷华州农村的一组儿童进行了研究,以确定农场及其他环境风险因素与四种哮喘结局之间的关联:医生诊断的哮喘、医生诊断的哮喘/喘息用药、当前喘息以及运动性咳嗽。医生诊断的哮喘患病率为12%,但在超过三分之一的队列中发现了这四种健康结局中的至少一种。对这四种健康结局的多变量模型分析发现,男性(三种哮喘结局)、年龄(三种哮喘结局)、个人过敏史(四种哮喘结局)、过敏性疾病家族史(两种哮喘结局)、早产(一种哮喘结局)、早期呼吸道感染(三种哮喘结局)、高危出生(两种哮喘结局)以及农场接触养猪和在饲料中添加抗生素(两种哮喘结局)之间存在独立关联。农村儿童哮喘及哮喘症状的高患病率凸显了哮喘筛查项目以及改善哮喘诊断和治疗的必要性。在饲养猪(44.1%,p = 0.01)以及饲养猪并在饲料中添加抗生素(55.8%,p = 0.013)的农场中生活的农场儿童,尽管特应性疾病发生率和个人过敏史较低,但哮喘健康结局的高患病率表明需要提高认识并采取预防措施,以及开展更多基于人群的研究,以进一步评估农场儿童哮喘的环境和遗传决定因素。