Hollenbach Jessica P, Schifano Elizabeth D, Hammel Christopher, Cloutier Michelle M
Asthma Center, Connecticut Children's Medical Center, Hartford, Connecticut, United States of America.
Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut, United States of America.
PLoS One. 2017 Mar 31;12(3):e0174541. doi: 10.1371/journal.pone.0174541. eCollection 2017.
To determine whether secondhand smoke (SHS) exposure is associated with greater asthma severity in children with physician-diagnosed asthma living in CT, and to examine whether area of residence, race/ethnicity or poverty moderate the association.
A large childhood asthma database in CT (Easy Breathing) was linked by participant zip code to census data to classify participants by area of residence. Multinomial logistic regression models, adjusted for enrollment date, sex, age, race/ethnicity, area of residence, insurance type, family history of asthma, eczema, and exposure to dogs, cats, gas stove, rodents and cockroaches were used to examine the association between self-reported exposure to SHS and clinician-determined asthma severity (mild, moderate, and severe persistent vs. intermittent asthma).
Of the 30,163 children with asthma enrolled in Easy Breathing, between 6 months and 18 years old, living in 161 different towns in CT, exposure to SHS was associated with greater asthma severity (adjusted relative risk ratio (aRRR): 1.07 [1.00, 1.15] and aRRR: 1.11 [1.02, 1.22] for mild and moderate persistent asthma, respectively). The odds of Black and Puerto Rican/Hispanic children with asthma being exposed to SHS were twice that of Caucasian children. Though the odds of SHS exposure for publicly insured children with asthma were three times greater than the odds for privately insured children (OR: 3.02 [2.84,3,21]), SHS exposure was associated with persistent asthma only among privately insured children (adjusted odds ratio (aOR): 1.23 [1.11,1.37]).
This is the first large-scale pragmatic study to demonstrate that children exposed to SHS in Connecticut have greater asthma severity, clinically determined using a systematic approach, and varies by insurance status.
确定对于居住在康涅狄格州（CT）且经医生诊断患有哮喘的儿童，接触二手烟（SHS）是否与更严重的哮喘相关，并研究居住地区、种族/民族或贫困状况是否会影响这种关联。
通过参与者的邮政编码将CT的一个大型儿童哮喘数据库（轻松呼吸）与人口普查数据相链接，以按居住地区对参与者进行分类。采用多项逻辑回归模型，对登记日期、性别、年龄、种族/民族、居住地区、保险类型、哮喘家族史、湿疹以及接触狗、猫、燃气炉、啮齿动物和蟑螂的情况进行了调整，以研究自我报告的SHS接触与临床医生确定的哮喘严重程度（轻度、中度和重度持续性哮喘与间歇性哮喘）之间的关联。
在参与“轻松呼吸”项目的30163名6个月至18岁、居住在CT 161个不同城镇的哮喘儿童中，接触SHS与更严重的哮喘相关（轻度和中度持续性哮喘的调整相对风险比（aRRR）分别为1.07 [1.00, 1.15] 和1.11 [1.02, 1.22]）。患有哮喘的黑人及波多黎各/西班牙裔儿童接触SHS的几率是白人儿童的两倍。虽然哮喘儿童中参加公共保险者接触SHS的几率比参加私人保险者大三倍（比值比（OR）：3.02 [2.84, 3.21]），但SHS接触仅在参加私人保险的儿童中与持续性哮喘相关（调整后的比值比（aOR）：1.23 [1.11, 1.37]）。
这是第一项大规模的实用研究，表明在康涅狄格州接触SHS的儿童哮喘严重程度更高，这是通过系统方法临床确定的，且因保险状况而异。
