Arathimos Ryan, Granell Raquel, Henderson John, Relton Caroline L, Tilling Kate
School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
Medical Research Council / University of Bristol Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom.
PLoS One. 2017 Apr 25;12(4):e0176293. doi: 10.1371/journal.pone.0176293. eCollection 2017.
Sex discordance in asthma prevalence has been previously reported, with higher prevalence in males before puberty, and in females after puberty; the adolescent "switch". However, cross-sectional studies have suggested a narrowing of this discordance in recent decades. We used a combination of cross-sectional and longitudinal modelling to examine sex differences in asthma, wheeze and longitudinal wheezing phenotypes in two UK birth cohorts, the Avon Longitudinal Study of Parents and Children (ALSPAC; born 1991-92 with data from age 0-18 years) and the Millennium Cohort Study (MCS; born 2000-02 with data from age 3-10 years). We derived measures of asthma and wheeze from questionnaires completed by mothers and cohort children. Previously-derived ALSPAC wheezing phenotype models were applied to MCS. Males had a higher prevalence of asthma at 10.7 years in ALSPAC (OR 1.45 95%CI: 1.26, 1.66 n = 7778 for current asthma) and MCS (OR 1.42 95%CI: 1.29, 1.56 n = 6726 for asthma ever) compared to females, decreasing in ALSPAC after puberty (OR 0.94 95%CI: 0.79, 1.11 n = 5023 for current asthma at 16.5 years). In longitudinal models using restricted cubic splines, males had a clear excess for asthma in the last 12 months and wheeze in the last 12 months up until 16.5 years of age in ALSPAC. Males had an increased risk of all derived longitudinal wheezing phenotypes in MCS when compared to never wheeze and no evidence of being at lower risk of late wheeze when compared to early wheeze. By comparing data in two large, contemporary cohorts we have shown the persistence of sex discordance in childhood asthma, with no evidence that the sex discordance is narrowing in recent cohorts.
先前已有报道称哮喘患病率存在性别差异，青春期前男性患病率较高，青春期后女性患病率较高；即青少年期的“转变”。然而，横断面研究表明，近几十年来这种差异正在缩小。我们结合横断面和纵向模型，在英国两个出生队列中研究哮喘、喘息及纵向喘息表型的性别差异，这两个队列分别是阿冯父母与儿童纵向研究（ALSPAC；出生于1991 - 1992年，有0至18岁的数据）和千禧队列研究（MCS；出生于2000 - 2002年，有3至10岁的数据）。我们从母亲和队列儿童填写的问卷中得出哮喘和喘息的测量数据。先前推导的ALSPAC喘息表型模型应用于MCS。与女性相比，在ALSPAC中10.7岁时男性哮喘患病率较高（当前哮喘的比值比为1.45，95%置信区间：1.26, 1.66，n = 7778），在MCS中（曾患哮喘的比值比为1.42，95%置信区间：1.29, 1.56，n = 6726）也是如此，在ALSPAC中青春期后患病率下降（16.5岁时当前哮喘的比值比为0.94，95%置信区间：0.79, 1.11，n = 5023）。在使用受限立方样条的纵向模型中，在ALSPAC中，直到16.5岁，男性在过去12个月患哮喘和喘息的情况明显更多。与从未喘息者相比，MCS中男性所有推导的纵向喘息表型风险增加，与早期喘息者相比，没有证据表明其晚期喘息风险较低。通过比较两个大型当代队列的数据，我们发现儿童哮喘中性别差异持续存在，没有证据表明在最近的队列中性别差异正在缩小。
