Department of Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada.
Ann Allergy Asthma Immunol. 2012 Oct;109(4):255-9. doi: 10.1016/j.anai.2012.07.020. Epub 2012 Aug 14.
Rural children have lower reported rates of asthma compared with urban children. Although reasons for these differences remain unclear, 3 possible explanations exist: (1) environmental differences, (2) variations in health care access, and (3) variations in health risk behaviors.
We investigated asthma among children living on farms and in small towns and its potential determinants, including personal, behavioral, and environmental factors.
School children (n = 842, ages 6-13; participation rate = 72.0%) were involved in a 2003 cross-sectional study. Their parents completed a lung health survey that included questions about asthma, asthma-like symptoms, and potential determinants of asthma (demographic, environmental, health risk behaviors). Participating children were classified into farm dwellers (live on farm or acreage) and small town dwellers. Multiple logistic regression was used to investigate the association between asthma and wheeze with demographic, environmental, and behavioral exposures with simultaneous adjustment for confounders.
Asthma and wheeze prevalence was not significantly different between farm and small town areas (current asthma: 16% vs 13%, respectively; current wheeze: 27% vs 21%, respectively) and followed consistent patterns. Factors associated with diagnosed asthma were dampness (odds ratio [OR] = 1.85; 95% confidence interval [CI] = 1.08-3.17), with enrollment in daycare found to be protective (OR = 0.53; 95% CI = 0.33-0.85). Being obese or overweight was associated with wheeze (OR = 1.77; 95% CI = 1.06-2.97).
Given the differences between areas and the associations between environmental risk factors and obesity with asthma and wheeze, the study findings support environment and health risk behavior explanations for the observed geographic variations.
与城市儿童相比，农村儿童报告的哮喘发病率较低。尽管造成这些差异的原因尚不清楚，但有 3 种可能的解释：（1）环境差异，（2）卫生保健获取的差异，以及（3）健康风险行为的差异。
我们研究了生活在农场和小镇的儿童中的哮喘及其潜在决定因素，包括个人、行为和环境因素。
2003 年，我们对 842 名（参与率为 72.0%）学龄儿童进行了一项横断面研究。他们的父母完成了一项肺部健康调查，其中包括有关哮喘、类哮喘症状和哮喘潜在决定因素（人口统计学、环境、健康风险行为）的问题。参与的儿童被分为居住在农场（居住在农场或英亩土地上）和居住在小镇的儿童。使用多变量逻辑回归来调查哮喘和喘息与人口统计学、环境和行为暴露之间的关联，同时调整混杂因素。
哮喘和喘息的发病率在农场和小镇地区之间没有显著差异（当前哮喘：分别为 16%和 13%；当前喘息：分别为 27%和 21%），且呈一致模式。与诊断性哮喘相关的因素包括潮湿（优势比[OR] = 1.85；95%置信区间[CI] = 1.08-3.17），发现入托保育具有保护作用（OR = 0.53；95% CI = 0.33-0.85）。肥胖或超重与喘息相关（OR = 1.77；95% CI = 1.06-2.97）。
鉴于地区之间的差异以及环境风险因素与肥胖与哮喘和喘息之间的关联，研究结果支持环境和健康风险行为解释观察到的地理变异。
