Kuehni C E, Strippoli M-P F, Low N, Brooke A M, Silverman M
Institute of Social and Preventive Medicine, Swiss Paediatric Respiratory Research Group, University of Bern, Bern, Switzerland.
Clin Exp Allergy. 2007 Dec;37(12):1738-46. doi: 10.1111/j.1365-2222.2007.02784.x.
Epidemiological data for south Asian children in the United Kingdom are contradictory, showing a lower prevalence of wheeze, but a higher rate of medical consultations and admissions for asthma compared with white children. These studies have not distinguished different asthma phenotypes or controlled for varying environmental exposures.
To compare the prevalence of wheeze and related health-service use in south Asian and white pre-schoolchildren in the United Kingdom, taking into account wheeze phenotype (viral and multiple wheeze) and environmental exposures.
A postal questionnaire was completed by parents of a population-based sample of 4366 white and 1714 south Asian children aged 1-4 years in Leicestershire, UK. Children were classified as having viral wheeze or multiple trigger wheeze.
The prevalence of current wheeze was 35.6% in white and 25.5% in south Asian 1-year-olds (P<0.001), and 21.9% and 20.9%, respectively, in children aged 2-4 years. Odds ratios (ORs) (95% confidence interval) for multiple wheeze and for viral wheeze, comparing south Asian with white children, were 2.21 (1.19-4.09) and 1.43 (0.77-2.65) in 2-4-year-olds after controlling for socio-economic conditions, environmental exposures and family history. In 1-year-olds, the respective ORs for multiple and viral wheeze were 0.66 (0.47-0.92) and 0.81 (0.64-1.03). Reported GP consultation rates for wheeze and hospital admissions were greater in south Asian children aged 2-4 years, even after adjustment for severity, but the use of inhaled corticosteroids was lower.
South Asian 2-4-year-olds are more likely than white children to have multiple wheeze (a condition with many features of chronic atopic asthma), after taking into account ethnic differences in exposure to some environmental agents. Undertreatment with inhaled corticosteroids might partly explain their greater use of health services.
英国南亚裔儿童的流行病学数据相互矛盾，与白人儿童相比，喘鸣患病率较低，但哮喘的医疗咨询和住院率较高。这些研究没有区分不同的哮喘表型，也没有对不同的环境暴露因素进行控制。
在考虑喘鸣表型（病毒性和多发性喘鸣）和环境暴露因素的情况下，比较英国南亚裔和白人学龄前儿童的喘鸣患病率及相关医疗服务使用情况。
英国莱斯特郡4366名白人儿童和1714名南亚裔儿童（年龄1至4岁）的父母完成了一份邮寄问卷。儿童被分为患有病毒性喘鸣或多发性触发因素喘鸣。
1岁白人儿童当前喘鸣患病率为35.6%，南亚裔儿童为25.5%（P<0.001）；2至4岁儿童中，这一比例分别为21.9%和20.9%。在控制社会经济状况、环境暴露因素和家族史后，2至4岁儿童中，南亚裔儿童与白人儿童相比，多发性喘鸣和病毒性喘鸣的比值比（OR）（95%置信区间）分别为2.21（1.19 - 4.09）和1.43（0.77 - 2.65）。在1岁儿童中，多发性喘鸣和病毒性喘鸣的相应OR分别为0.66（0.47 - 0.92）和0.81（0.64 - 1.03）。2至4岁南亚裔儿童因喘鸣报告的全科医生咨询率和住院率更高，即使在对严重程度进行调整后也是如此，但吸入性糖皮质激素的使用较低。
在考虑到接触某些环境因素的种族差异后，2至4岁的南亚裔儿童比白人儿童更易患多发性喘鸣（一种具有许多慢性特应性哮喘特征的疾病）。吸入性糖皮质激素治疗不足可能部分解释了他们更多地使用医疗服务的原因。
