Children's Hospital, London Health Sciences Centre, London, Ontario, Canada; Department of Pediatrics, Western University, London, Ontario, Canada; Institute for Clinical Evaluative Sciences, London, Ontario, Canada.
Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
J Allergy Clin Immunol. 2014 Nov;134(5):1057-62.e5. doi: 10.1016/j.jaci.2014.05.012. Epub 2014 Jun 27.
The cause of rising asthma incidence over time remains unexplained. Examining trends in the age of diagnosis across successive birth cohorts may offer insights into asthma etiology.
To examine trends in the age at asthma diagnosis and the age and proportion of children hospitalized at first asthma diagnosis in Ontario, Canada.
Eight consecutive birth cohorts of children (1993-2000) were observed using administrative data from a universal health insurance plan in Ontario, Canada (population 13 million). Trends in the need for hospitalization and age at asthma diagnosis were examined with descriptive and survival analyses.
The records of 1,059,511 children were examined, of whom 201,958 developed asthma in the first 8 years of life, with an average cumulative incidence of 19.1%. Mean age at asthma diagnosis decreased from 4.7 ± 1.5 years in birth year 1993 to 2.6 ± 2.0 years in birth year 2000 (P < .0001), with a higher adjusted risk of asthma diagnosis (hazard ratio, 6.7; 95% CI, 6.5-6.9) in the first 3 years of life for children born after 1996 versus children born in the period 1993 to 1995 (hazard ratio, 1.4; 95% CI, 1.3-1.4). The proportion of children hospitalized at asthma diagnosis stayed stable while the age at first asthma hospitalization decreased over time (P < .0001).
This study demonstrates a significant increase in asthma incidence and a decrease in the age of asthma diagnosis across multiple birth cohorts. Changes in asthma incidence over time are primarily explained by variations in asthma rates in children younger than 3 years.
哮喘发病率随时间上升的原因仍未得到解释。检查连续出生队列中诊断年龄的趋势可能为哮喘病因学提供见解。
检查加拿大安大略省哮喘诊断年龄以及首次哮喘诊断时住院的年龄和比例的趋势。
使用加拿大安大略省全民健康保险计划的行政数据，观察了 8 个连续的儿童出生队列（1993-2000 年）。使用描述性和生存分析检查了住院需求和哮喘诊断年龄的趋势。
检查了 1059511 名儿童的记录，其中 201958 名在生命的头 8 年患上哮喘，累积发病率平均为 19.1%。哮喘诊断的平均年龄从 1993 年出生年份的 4.7 ± 1.5 岁降至 2000 年出生年份的 2.6 ± 2.0 岁（P <.0001），出生于 1996 年后的儿童与出生于 1993 年至 1995 年期间的儿童相比，前 3 年诊断出哮喘的风险更高（调整风险比，6.7；95%CI，6.5-6.9）（调整风险比，1.4；95%CI，1.3-1.4）。首次哮喘住院年龄的下降而住院比例保持稳定。
本研究表明，在多个出生队列中，哮喘发病率显著增加，哮喘诊断年龄降低。随时间推移哮喘发病率的变化主要归因于 3 岁以下儿童哮喘发病率的变化。
