Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany.
J Allergy Clin Immunol. 2014 Apr;133(4):979-88. doi: 10.1016/j.jaci.2013.11.035. Epub 2014 Jan 22.
The lack of longitudinal data analyses from birth to adulthood is hampering long-term asthma prevention strategies.
We aimed to determine early-life predictors of asthma incidence up to age 20 years in a birth cohort study by applying time-to-event analysis.
In 1990, the Multicenter Allergy Study included 1314 newborns in 5 German cities. Children were evaluated from birth to age 20 years at 19 time points. Using a Cox regression model, we examined the associations between 36 early-life factors and onset of asthma based on a doctor's diagnosis or asthma medication (primary outcome), typical asthma symptoms, or allergic asthma (including positive IgE measurements).
Response at 20 years was 71.6%. Two hundred eighteen subjects met the primary outcome criteria within 16,257 person years observed. Asthma incidence was lower in participants who were vaccinated (measles, mumps, and rubella vaccine/tick-borne encephalitis vaccine/BCG vaccine: adjusted hazard ratio [HR], 0.66 [95% CI, 0.47-0.93]). Up to age 20 years, asthma incidence was higher in subjects who had parents with allergic rhinitis (adjusted HR, 2.24 [95% CI, 1.67-3.02]), started day care early or late (before 18 months: adjusted HR, 1.79 [95% CI, 1.03-3.10]; after 3 years: adjusted HR, 1.64 [95% CI, 0.96-2.79]), had mothers who smoked during pregnancy (adjusted HR, 1.79 [95% CI, 1.20-2.67]), had poor parents (adjusted HR, 1.55 [95% CI, 1.09-2.22]), and had parents with asthma (adjusted HR, 1.65 [95% CI, 1.17-2.31]). Not associated with asthma were aspects of diet and breast-feeding, pet ownership, presence of older siblings, and passive smoking.
Parental asthma and nasal allergy increase asthma incidence in offspring up to adulthood. Avoiding tobacco smoke exposure during pregnancy, receiving vaccinations in early childhood, and starting day care between 1.5 and 3 years of age might prevent or delay the development of asthma.
缺乏从出生到成年的纵向数据分析，阻碍了长期哮喘预防策略的制定。
我们旨在通过时间事件分析，确定在一项出生队列研究中，20 岁前哮喘发病的早期生命预测因素。
1990 年，多中心过敏研究纳入了 5 个德国城市的 1314 名新生儿。从出生到 20 岁，儿童在 19 个时间点进行评估。使用 Cox 回归模型，我们根据医生诊断或哮喘药物（主要结局）、典型哮喘症状或过敏性哮喘（包括阳性 IgE 测量值），检查了 36 个早期生命因素与哮喘发病之间的关联。
20 年时的应答率为 71.6%。在观察到的 16257 人年中，有 218 名受试者符合主要结局标准。接种疫苗的参与者（麻疹、腮腺炎和风疹疫苗/蜱传脑炎疫苗/卡介苗疫苗）的哮喘发病率较低（调整后的危险比[HR]，0.66 [95%CI，0.47-0.93]）。截至 20 岁时，父母患有过敏性鼻炎的受试者（调整后的 HR，2.24 [95%CI，1.67-3.02]）、早期或晚期（18 个月前：调整后的 HR，1.79 [95%CI，1.03-3.10]；3 年后：调整后的 HR，1.64 [95%CI，0.96-2.79]）进入日托机构、母亲在怀孕期间吸烟（调整后的 HR，1.79 [95%CI，1.20-2.67]）、父母经济条件差（调整后的 HR，1.55 [95%CI，1.09-2.22]）和父母患有哮喘（调整后的 HR，1.65 [95%CI，1.17-2.31]）的哮喘发病率较高。饮食和母乳喂养、养宠物、有兄弟姐妹和被动吸烟与哮喘无关。
父母哮喘和鼻过敏会增加子女成年后患哮喘的风险。避免孕妇吸烟、在幼儿期接种疫苗、1.5 至 3 岁时开始入托，可能预防或延缓哮喘的发生。
