与学龄前儿童医生诊断哮喘发病率相关的早期生活因素:加拿大儿童早期发展队列研究结果
Early life factors associated with incidence of physician-diagnosed asthma in preschool children: results from the Canadian Early Childhood Development cohort study.
作者信息
Midodzi William K, Rowe Brian H, Majaesic Carina M, Saunders Leslie Duncan, Senthilselvan Ambikaipakan
机构信息
Epidemiology Coordinating and Research (EPICORE) Centre, University of Alberta, Edmonton, Alberta, Canada T6G7T4.
出版信息
J Asthma. 2010 Feb;47(1):7-13. doi: 10.3109/02770900903380996.
Background. Asthma is a common childhood illness. The objective of this study is to determine the incidence of physician-diagnosed asthma in preschool years and its relationship to host, prenatal and postnatal factors, early childhood factors, parental factors, household factors and demographic factors. Methods. The study sample was comprised of 8,499 infants and toddlers (<2 years at baseline) enrolled in the Canadian Early Childhood Development Study. Incidence of asthma was determined when the children were in preschool age (2 to 5 years). Results. The 4-year cumulative incidence at preschool age was 13.7% for physician-diagnosed asthma. History of early childhood wheezing before 2 years of age was a significant risk factor for incidence of asthma in preschool years (hazard ratio (HR): 2.32; 95% confidence interval (CI): 2.04-2.65). Factors that were protective for the development of asthma were breastfeeding more than 3 months (HR: 0.82; 95% CI: 0.69-0.97); history of nose or throat infection often in childhood (HR: 0.79; 95% CI: 0.67-0.93); early daycare attendance (HR: 0.85; 95% CI: 0.74-0.98); presence of two or more siblings at birth, (HR: 0.79; 95% CI: 0.64-0.97); and dwelling in rural non- central metropolitan areas (HR: 0.81; 95% CI: 0.69-0.95). Male sex, low birth weight, childhood allergy, single parent, maternal smoking during pregnancy, maternal medication use, parental atopy, and low SES at baseline were significant risk factors for the incidence of physician-diagnosed asthma in preschool years. Conclusion. This study emphasizes the role of wheezing in infant and toddler age on early onset of asthma during preschool years. The results also provide additional importance of early exposures to environmental factors such as early infections, daycare attendance, and rural environment in the development of proper immune dynamics to prevent asthma.
背景。哮喘是一种常见的儿童疾病。本研究的目的是确定学龄前医生诊断哮喘的发病率及其与宿主、产前和产后因素、幼儿期因素、父母因素、家庭因素和人口统计学因素的关系。方法。研究样本包括8499名婴儿和幼儿(基线时年龄小于2岁),他们参与了加拿大儿童早期发展研究。哮喘发病率在儿童学龄前(2至5岁)时确定。结果。学龄前4年累计医生诊断哮喘发病率为13.7%。2岁前幼儿喘息史是学龄前哮喘发病的一个重要危险因素(风险比(HR):2.32;95%置信区间(CI):2.04 - 2.65)。对哮喘发展有保护作用的因素包括母乳喂养超过3个月(HR:0.82;95%CI:0.69 - 0.97);儿童期经常出现鼻或喉感染史(HR:0.79;95%CI:0.67 - 0.93);早期入托(HR:0.85;95%CI:0.74 - 0.98);出生时存在两个或更多兄弟姐妹(HR:0.79;95%CI:0.64 - 0.97);以及居住在农村非中心大都市地区(HR:0.81;95%CI:0.69 - 0.95)。男性、低出生体重、儿童过敏、单亲、孕期母亲吸烟、母亲用药、父母特应性以及基线时低社会经济地位是学龄前医生诊断哮喘发病率的重要危险因素。结论。本研究强调了婴幼儿期喘息在学龄前哮喘早期发病中的作用。研究结果还进一步表明,早期接触环境因素如早期感染、入托和农村环境对于发展适当的免疫动态以预防哮喘具有重要意义。