Bjerg A, Hedman L, Perzanowski M, Wennergren G, Lundbäck B, Rönmark E
Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Gothenburg, Sweden; Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, the OLIN Unit, Umeå University, Umeå, Sweden.
Clin Exp Allergy. 2015 Jan;45(1):146-53. doi: 10.1111/cea.12439.
The large increase in asthma prevalence continues in several, but not all areas. Despite the individual risk factors that have been identified, the reasons for the observed trends in prevalence are largely unknown.
This study sought to characterize what trends in risk factors accompanied trends in asthma prevalence.
Two population-based cohorts of 7- to 8-year-old children from the same Swedish study areas examined by expanded International Study of Asthma and Allergy in Childhood questionnaires were compared 10 years apart. In 1996 and 2006, 3430 (97% participation) and 2585 (96% participation) questionnaires were completed, respectively. A subset was skin-prick-tested: in 1996 and 2006, 2148 (88% participation) and 1700 (90% participation) children, respectively. The adjusted population-attributable fraction (aPAF) was calculated using the prevalence and multivariate odds ratio of each risk factor.
The prevalence of current asthma and wheeze was similar in 1996 and 2006. Allergic sensitization, however, increased from 21% to 30%. The prevalence of parental asthma increased from 17% to 24%, while respiratory infections and maternal smoking decreased (60% to 29% and 32% to 16%, respectively). The aPAFs of non-environmental risk factors for current asthma increased in 1996-2006: allergic sensitization from 35% to 41%, parental asthma from 27% to 45% and male sex from 20% to 25%. Conversely, the aPAFs of environmental risk factors decreased: respiratory infections from 36% to 32% and damp home and maternal smoking from 14% and 19%, respectively, to near zero in 2006.
From 1996 to 2006, the non-environmental risk factors parental asthma, allergic sensitization and male sex had an increasing or constant importance for current asthma in 7- to 8-year-old children. The importance of the environmental exposures damp home, respiratory infections and maternal smoking decreased. This counterbalancing in risk factors may explain the level of prevalence of current asthma.
哮喘患病率在部分地区持续大幅上升，但并非所有地区都是如此。尽管已确定了个体风险因素，但患病率出现上述趋势的原因在很大程度上仍不清楚。
本研究旨在确定哪些风险因素的趋势与哮喘患病率的趋势相伴。
对来自瑞典同一研究地区的两组以人群为基础的队列进行比较，这两组队列由7至8岁儿童组成，通过扩展的儿童哮喘和过敏国际研究问卷进行调查，时间间隔为10年。1996年和2006年分别完成了3430份（参与率97%）和2585份（参与率96%）问卷。对其中一部分儿童进行了皮肤点刺试验：1996年和2006年分别有2148名（参与率88%）和1700名（参与率90%）儿童接受了测试。使用每个风险因素的患病率和多变量优势比计算调整后的人群归因分数（aPAF）。
1996年和2006年当前哮喘和喘息的患病率相似。然而，过敏致敏率从21%上升至30%。父母患哮喘的比例从17%升至24%，而呼吸道感染和母亲吸烟的比例下降（分别从60%降至29%和从32%降至16%）。1996 - 2006年，当前哮喘的非环境风险因素的aPAF有所增加：过敏致敏从35%升至41%，父母患哮喘从27%升至45%，男性从20%升至25%。相反，环境风险因素的aPAF下降：呼吸道感染从36%降至32%，潮湿的家庭环境和母亲吸烟分别从14%和19%降至2006年的接近零。
1996年至2006年，父母患哮喘、过敏致敏和男性等非环境风险因素对7至8岁儿童当前哮喘的影响日益增加或保持不变。家庭潮湿、呼吸道感染和母亲吸烟等环境暴露因素的影响下降。这些风险因素的相互平衡可能解释了当前哮喘的患病率水平。
