心理压力与儿童哮喘住院治疗：两个北欧国家的全国队列研究。
Psychological stress and hospitalization for childhood asthma-a nationwide cohort study in two Nordic countries.
机构信息
Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark ; Department of Epidemiology and Social Science on Reproductive Health, Shanghai Institute of Planned Parenthood Research, WHO Collaborating Center for Research in Human Reproduction, National Population & Family Planning Key Laboratory of Contraceptive Drugs and Devices, Shanghai, China.
出版信息
PLoS One. 2013 Oct 25;8(10):e78816. doi: 10.1371/journal.pone.0078816. eCollection 2013.
OBJECTIVE
Exposures to psychological stress in early life may contribute to the development or exacerbation of asthma. We undertook a cohort study based on data from several population-based registers in Denmark and Sweden to examine whether bereavement in childhood led to increased asthma hospitalization.
METHODS
All singleton children born in Denmark during 1977-2008 and in Sweden during 1973-2006 were included in the study (N=5,202,576). The children were followed from birth to the date of first asthma hospitalization, emigration, death, their 18(th) birthday, or the end of study (31 December 2007 in Sweden and 31 December 2008 in Denmark), whichever came first. All the children were assigned to the non-bereaved group until they lost a close relative (mother, father or a sibling), from when they were included in the bereaved group. We evaluated the hazard ratio (HR) of first hospitalization for asthma in bereaved children using Cox proportional hazards regression models, compared to those who were in the non-bereaved group. We also did a sub-analysis on the association between bereavement and first asthma medication.
RESULTS
A total of 147,829 children were hospitalized for asthma. The overall adjusted HR of asthma hospitalization in bereaved children was 1.10 (95% confidence interval (CI): 1.04-1.16), compared to non-bereaved children. The risk of asthma hospitalization was increased in those who lost a close relative at age of 14-17 years (HR=1.54, 95% CI: 1.23-1.92), but not in younger age groups. The association between bereavement and asthma hospitalization did not change over time since bereavement. In the sub-analysis in singleton live births during 1996-2008 recorded in the DMBR, bereavement was associated with a lower use of asthma medication (HR=0.87, 95% CI: 0.80-0.95).
CONCLUSIONS
Our data suggests that psychological stress following bereavement in late adolescence is associated with an increased risk of asthma hospitalization or lowers the threshold for asthma hospitalization.
目的
儿童早期经历心理压力可能会导致哮喘的发生或加重。我们在丹麦和瑞典的几个基于人群的登记处进行了一项队列研究，以检验儿童时期丧亲是否会导致哮喘住院率增加。
方法
本研究纳入了 1977 年至 2008 年期间在丹麦出生的所有单胎儿童和 1973 年至 2006 年期间在瑞典出生的所有单胎儿童（n=5202576）。从出生开始，对儿童进行随访，直至首次哮喘住院、移民、死亡、18 岁生日或研究结束（2007 年 12 月 31 日在瑞典，2008 年 12 月 31 日在丹麦），以先发生者为准。所有儿童在失去直系亲属（母亲、父亲或兄弟姐妹）之前均被归入非丧亲组，从归入丧亲组开始。我们使用 Cox 比例风险回归模型评估丧亲儿童首次哮喘住院的风险比（HR），并与非丧亲组进行比较。我们还对丧亲和首次哮喘药物治疗之间的关系进行了亚分析。
结果
共有 147829 名儿童因哮喘住院。与非丧亲儿童相比，丧亲儿童哮喘住院的总体调整后 HR 为 1.10（95%置信区间（CI）：1.04-1.16）。在 14-17 岁失去直系亲属的儿童中，哮喘住院的风险增加（HR=1.54，95%CI：1.23-1.92），但在年龄较小的儿童中则不然。丧亲与哮喘住院之间的关联并未随丧亲时间的推移而改变。在 1996 年至 2008 年期间记录的 DMBR 中，对单胎活产儿的亚分析表明，丧亲与哮喘药物使用率降低相关（HR=0.87，95%CI：0.80-0.95）。
结论
我们的数据表明，青春期晚期丧亲导致的心理压力与哮喘住院风险增加或哮喘住院阈值降低有关。
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