Graham N M
Department of Epidemiology, Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD 21205.
Epidemiol Rev. 1990;12:149-78. doi: 10.1093/oxfordjournals.epirev.a036050.
While a number of advances have been made in our understanding of the epidemiology of acute respiratory infections in the past two decades, a number of serious questions still require urgent answers. The associations of factors such as chronic disease in adults, direct smoking, passive smoking, crowding, and breast feeding to acute respiratory infections are now well documented. Appropriate changes in public health policy need not be predicated on results from still further studies. However, in virtually all of the other areas cited in this review, further data are required. In developing countries, studies being currently conducted on vitamin A supplementation, malnutrition, and indoor air pollution will help address the most pressing issues. More studies are also needed on the relations between HIV infection and acute respiratory infections, as well as low birth weight and respiratory infection. The National Research Council studies have provided important additional data on etiologic agents in children in developing countries, but data on adult pneumonia remain sparse. In developed countries the issues that may be of greatest interest are the relation between maternal antibody levels and passive immunity in infants, the reasons for the increase in pneumonia mortality in older age groups, and the relation between air pollution and acute respiratory infections (as opposed to morbidity from bronchial reactivity). From a methodological viewpoint, the relation between previous respiratory infection (particularly in the first year of life) and subsequent acute respiratory infection morbidity has been inadequately explored. Adjustment for autocorrelation in multivariate models may be necessary if this relation is strong. Greater standardization of data collection methods in developed and developing countries also needs to be more seriously addressed. Given that some advances have been made in this area, the time may be right for development of acute symptom questionnaires, akin to the American Thoracic Society chronic respiratory questionnaire, for use in both developed and developing countries. Standardization of diaries, although somewhat more difficult, would also be extremely useful in many instances.
在过去二十年里，我们对急性呼吸道感染流行病学的认识取得了一些进展，但仍有一些严重问题亟待解答。成人慢性病、直接吸烟、被动吸烟、拥挤环境和母乳喂养等因素与急性呼吸道感染之间的关联现已得到充分记录。公共卫生政策的适当调整无需依赖进一步研究的结果。然而，在本综述提及的几乎所有其他领域，都需要更多数据。在发展中国家，目前正在进行的关于补充维生素A、营养不良和室内空气污染的研究将有助于解决最紧迫的问题。还需要更多关于艾滋病毒感染与急性呼吸道感染以及低出生体重与呼吸道感染之间关系的研究。国家研究委员会的研究提供了关于发展中国家儿童病原体的重要补充数据，但关于成人肺炎的数据仍然稀少。在发达国家，最受关注的问题可能是母体抗体水平与婴儿被动免疫之间的关系、老年人群肺炎死亡率上升的原因，以及空气污染与急性呼吸道感染之间的关系（与支气管反应性导致的发病率相对）。从方法学角度来看，既往呼吸道感染（尤其是在生命的第一年）与随后急性呼吸道感染发病率之间的关系尚未得到充分探讨。如果这种关系很强，在多变量模型中对自相关进行调整可能是必要的。发达国家和发展中国家数据收集方法的更大标准化也需要更认真地加以解决。鉴于该领域已取得一些进展，现在可能是开发急性症状问卷的时候了，类似于美国胸科学会的慢性呼吸道问卷，供发达国家和发展中国家使用。日记的标准化虽然难度稍大，但在许多情况下也会非常有用。
