Leung June Y Y, Lam Hugh S, Leung Gabriel M, Schooling C Mary
School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
Paediatr Perinat Epidemiol. 2016 Mar;30(2):149-59. doi: 10.1111/ppe.12273. Epub 2016 Jan 6.
Preterm birth, early term birth, and low birthweight are associated with childhood wheezing disorders in developed Western settings, but observed associations could be confounded by socio-economic position. This study aims to clarify such associations in a developed non-Western setting with a different confounding structure.
Using Cox regression, we examined the adjusted associations of gestational age and birthweight for gestational age with time to first public hospital admission for asthma, bronchitis, and bronchiolitis (International Classification of Diseases, Ninth Version Clinical Modification 466, 490, and 493) from 9 days to 12 years in a population-representative birth cohort of 8327 Chinese children in Hong Kong, a developed setting with less clear social patterning of prematurity or birthweight. Analyses were adjusted for infant and parental characteristics and socio-economic position.
Children born late preterm (34 to <37 weeks) had higher risk of hospitalisation for asthma and other wheezing disorders [hazard ratio (HR) 1.99, 95% confidence interval (CI) 1.48, 2.67] than children born full term (39 to <41 weeks). Early term births (37 to <39 weeks) had HR 1.01 (95% CI 0.84, 1.22), late term births (41 to <42 weeks) had HR 0.77 (95% 0.59, 1.01), and post-term births (≥42 weeks) had HR 0.56 (95% CI 0.32, 0.98). Large for gestational age was associated with lower risk of hospitalisation (HR 0.76, 95% CI 0.57, 0.99).
The association of preterm birth with childhood wheezing could be biologically mediated. We cannot rule out an association for early term births.
在西方发达国家，早产、早期足月产和低出生体重与儿童喘息性疾病有关，但观察到的关联可能会受到社会经济地位的混淆。本研究旨在阐明在具有不同混杂结构的非西方发达国家中此类关联。
我们使用Cox回归分析了香港8327名具有代表性的中国儿童出生队列中，胎龄和根据胎龄调整后的出生体重与首次因哮喘、支气管炎和细支气管炎（国际疾病分类第九版临床修订版466、490和493）入住公立医院的时间之间的校正关联，时间跨度为9天至12岁，香港是一个早产或出生体重社会模式不太明显的发达地区。分析对婴儿和父母特征以及社会经济地位进行了校正。
晚期早产儿（34至<37周）因哮喘和其他喘息性疾病住院的风险高于足月儿（39至<41周）[风险比（HR）1.99，95%置信区间（CI）1.48，2.67]。早期足月儿（37至<39周）的HR为1.01（95%CI 0.84，1.22），晚期足月儿（41至<42周）的HR为0.77（95%CI 0.59，1.01），过期产儿（≥42周）的HR为0.56（95%CI 0.32，0.98）。大于胎龄儿与较低的住院风险相关（HR 0.76，95%CI 0.57，0.99）。
早产与儿童喘息之间的关联可能是由生物学介导的。我们不能排除早期足月产存在关联。
