Gold Diane R, Wright Rosalind
Harvard Medical School, Channing Laboratory, Brigham and Women's Hospital, Boston, Massachusetts 02467, USA.
Annu Rev Public Health. 2005;26:89-113. doi: 10.1146/annurev.publhealth.26.021304.144528.
The prevalence of asthma in the United States is higher than in many other countries in the world. Asthma, the most common chronic disease of childhood in the United States, disproportionately burdens many socioeconomically disadvantaged urban communities. In this review we discuss hypotheses for between-country disparities in asthma prevalence, including differences in "hygiene" (e.g., family size, use of day care, early-life respiratory infection exposures, endotoxin and other farm-related exposures, microbial colonization of the infant bowel, exposure to parasites, and exposure to large domestic animal sources of allergen), diet, traffic pollution, and cigarette smoking. We present data on socioeconomic and ethnic disparities in asthma prevalence and morbidity in the United States and discuss environmental factors contributing to asthma disparities (e.g., housing conditions, indoor environmental exposures including allergens, traffic air pollution, disparities in treatment and access to care, and cigarette smoking). We discuss environmental influences on somatic growth (low birth weight, prematurity, and obesity) and their relevance to asthma disparities. The relevance of the hygiene hypothesis to the U.S. urban situation is reviewed. Finally, we discuss community-level factors contributing to asthma disparities.
美国哮喘的患病率高于世界上许多其他国家。哮喘是美国儿童最常见的慢性病，给许多社会经济地位不利的城市社区带来了不成比例的负担。在这篇综述中，我们讨论了各国哮喘患病率差异的假说，包括“卫生”方面的差异（如家庭规模、日托使用情况、早期呼吸道感染暴露、内毒素和其他与农场相关的暴露、婴儿肠道微生物定植、寄生虫暴露以及接触大型家畜过敏原来源）、饮食、交通污染和吸烟。我们展示了美国哮喘患病率和发病率在社会经济和种族方面的差异数据，并讨论了导致哮喘差异的环境因素（如住房条件、包括过敏原在内的室内环境暴露、交通空气污染、治疗和获得医疗服务方面的差异以及吸烟）。我们讨论了环境对身体生长（低出生体重、早产和肥胖）的影响及其与哮喘差异的相关性。综述了卫生假说与美国城市情况的相关性。最后，我们讨论了导致哮喘差异的社区层面因素。
