Pesce Giancarlo, Locatelli Francesca, Cerveri Isa, Bugiani Massimiliano, Pirina Pietro, Johannessen Ane, Accordini Simone, Zanolin Maria Elisabetta, Verlato Giuseppe, de Marco Roberto
Unit of Epidemiology & Medical Statistics, Dept. of Public Health & Community Medicine, University of Verona, Verona, Italy.
Unit of Respiratory Diseases, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
PLoS One. 2015 Oct 6;10(10):e0138570. doi: 10.1371/journal.pone.0138570. eCollection 2015.
It is well known that asthma prevalence has been increasing all over the world in the last decades. However, few data are available on temporal trends of incidence and remission of asthma.
To evaluate the rates of asthma incidence and remission in Italy from 1940 to 2010.
The subjects were randomly sampled from the general Italian population between 1991 and 2010 in the three population-based multicentre studies: ECRHS, ISAYA, and GEIRD. Individual information on the history of asthma (age at onset, age at the last attack, use of drugs for asthma control, co-presence of hay-fever) was collected on 35,495 subjects aged 20-84 and born between 1925-1989. Temporal changes in rates of asthma incidence and remission in relation to age, birth cohort and calendar period (APC) were modelled using Poisson regression and APC models.
The average yearly rate of asthma incidence was 2.6/1000 (3,297 new cases among 1,263,885 person-years). The incidence rates have been linearly increasing, with a percentage increase of +3.9% (95%CI: 3.1-4.5), from 1940 up to the year 1995, when the rates begun to level off. The stabilization of asthma incidence was mainly due to a decrease in the rates of atopic asthma after 1995, while non-atopic asthma has continued to increase. The overall rate of remission was 43.2/1000person-years, and it did not vary significantly across generations, but was associated with atopy, age at asthma onset and duration of the disease.
After 50 years of a continuous upward trend, the rates of asthma incidence underwent a substantial stabilization in the late 90s. Despite remarkable improvements in the treatment of asthma, the rate of remission did not change significantly in the last seventy years. Some caveats are required in interpreting our results, given that our estimates are based on self-reported events that could be affected by the recall bias.
众所周知，在过去几十年里，全球哮喘患病率一直在上升。然而，关于哮喘发病率和缓解率的时间趋势的数据却很少。
评估1940年至2010年意大利的哮喘发病率和缓解率。
在三项基于人群的多中心研究（欧洲社区呼吸健康调查、意大利哮喘和慢性阻塞性肺疾病研究、意大利呼吸道疾病遗传和环境决定因素研究）中，于1991年至2010年从意大利普通人群中随机抽样。收集了35495名年龄在20 - 84岁、出生于1925年至1989年的受试者关于哮喘病史（发病年龄、最后一次发作年龄、用于哮喘控制的药物使用情况、是否合并花粉热）的个人信息。使用泊松回归和年龄 - 时期 - 队列模型对哮喘发病率和缓解率随年龄、出生队列和日历时期（APC）的时间变化进行建模。
哮喘的平均年发病率为2.6/1000（在1263885人年中有3297例新发病例）。从1940年到1995年发病率呈线性上升，上升百分比为 +3.9%（95%置信区间：3.1 - 4.5），1995年后发病率开始趋于平稳。哮喘发病率的稳定主要是由于1995年后特应性哮喘发病率下降，而非特应性哮喘继续上升。总体缓解率为43.2/1000人年，不同代之间无显著差异，但与特应性、哮喘发病年龄和疾病持续时间有关。
经过50年的持续上升趋势后，哮喘发病率在90年代后期大幅稳定下来。尽管哮喘治疗有显著改善，但在过去70年中缓解率没有显著变化。鉴于我们的估计基于自我报告事件，可能受到回忆偏倚的影响，在解释我们的结果时需要一些注意事项。
