Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA.
Environ Health. 2012 Sep 18;11:66. doi: 10.1186/1476-069X-11-66.
In the United States, asthma is the most common chronic disease of childhood across all socioeconomic classes and is the most frequent cause of hospitalization among children. Asthma exacerbations have been associated with exposure to residential indoor environmental stressors such as allergens and air pollutants as well as numerous additional factors. Simulation modeling is a valuable tool that can be used to evaluate interventions for complex multifactorial diseases such as asthma but in spite of its flexibility and applicability, modeling applications in either environmental exposures or asthma have been limited to date.
We designed a discrete event simulation model to study the effect of environmental factors on asthma exacerbations in school-age children living in low-income multi-family housing. Model outcomes include asthma symptoms, medication use, hospitalizations, and emergency room visits. Environmental factors were linked to percent predicted forced expiratory volume in 1 second (FEV1%), which in turn was linked to risk equations for each outcome. Exposures affecting FEV1% included indoor and outdoor sources of NO2 and PM2.5, cockroach allergen, and dampness as a proxy for mold.
Model design parameters and equations are described in detail. We evaluated the model by simulating 50,000 children over 10 years and showed that pollutant concentrations and health outcome rates are comparable to values reported in the literature. In an application example, we simulated what would happen if the kitchen and bathroom exhaust fans were improved for the entire cohort, and showed reductions in pollutant concentrations and healthcare utilization rates.
We describe the design and evaluation of a discrete event simulation model of pediatric asthma for children living in low-income multi-family housing. Our model simulates the effect of environmental factors (combustion pollutants and allergens), medication compliance, seasonality, and medical history on asthma outcomes (symptom-days, medication use, hospitalizations, and emergency room visits). The model can be used to evaluate building interventions and green building construction practices on pollutant concentrations, energy savings, and asthma healthcare utilization costs, and demonstrates the value of a simulation approach for studying complex diseases such as asthma.
在美国，哮喘是所有社会经济阶层儿童中最常见的慢性疾病，也是儿童住院的最常见原因。哮喘恶化与接触住宅室内环境应激源有关，如过敏原和空气污染物，以及许多其他因素。仿真建模是一种有价值的工具，可用于评估复杂多因素疾病（如哮喘）的干预措施，但尽管其具有灵活性和适用性，建模应用在环境暴露或哮喘方面迄今为止一直受到限制。
我们设计了一个离散事件仿真模型，以研究居住在低收入多户住宅中的学龄儿童的环境因素对哮喘恶化的影响。模型结果包括哮喘症状、药物使用、住院和急诊就诊。环境因素与预计用力呼气量的百分比（FEV1%）相关，FEV1% 又与每种结果的风险方程相关。影响 FEV1%的暴露因素包括室内和室外的 NO2 和 PM2.5 源、蟑螂过敏原以及潮湿（霉菌的替代品）。
详细描述了模型设计参数和方程。我们通过模拟 50,000 名儿童 10 年的数据来评估模型，并表明污染物浓度和健康结果率与文献报告的值相当。在一个应用示例中，我们模拟了如果整个队列的厨房和浴室排气扇得到改善会发生什么情况，并显示出污染物浓度和医疗保健利用率的降低。
我们描述了一种用于居住在低收入多户住宅中的儿童的儿科哮喘离散事件仿真模型的设计和评估。我们的模型模拟了环境因素（燃烧污染物和过敏原）、药物依从性、季节性和病史对哮喘结果（症状天数、药物使用、住院和急诊就诊）的影响。该模型可用于评估建筑物干预措施和绿色建筑施工实践对污染物浓度、节能和哮喘医疗保健利用成本的影响，并展示了仿真方法在研究复杂疾病（如哮喘）方面的价值。
