Lin Sheng-Chieh, Lin Hui-Wen, Chiang Bor-Luen
Department of Pediatrics, Shuang Ho Hospital Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University Department of Mathematics, Soochow University Evidence Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Medicine (Baltimore). 2017 Sep;96(35):e7667. doi: 10.1097/MD.0000000000007667.
Asthma and croup are common inflammatory airway diseases involving the bronchus in children. However, no study has reported the effects of urbanization, sex, age, and bronchiolitis on the association of croup and its duration with asthma development. We used the Taiwan Longitudinal Health Insurance Database (LHID) to perform this population-based cohort study; here, the cluster effect caused by hospitalization was considered to evaluate the association between croup and asthma development and the risk factors for asthma in children of different age groups. We evaluated children with croup aged <12 years (n = 1204) and age-matched control patients (n = 140,887) by using Cox proportional hazards regression analysis within a hospitalization cluster. Of all 142,091 patients, 5799 (including 155 with croup [419 per 1000 person-y] and 5644 controls [106 per 1000 person-y]) had asthma during the 5-year follow-up period. During the 5-year follow-up period, the hazard ratios (HRs [95% CIs]) for asthma were 2.10 (1.81-2.44) in all children with croup, 2.13 (1.85-2.46) in those aged 0 to 5 years, and 2.22 (1.87-2.65) in those aged 6 to 12 years. Children with croup aged 7 to 9 years had a higher HR for asthma than did those in other age groups. Boys with croup had a higher HR for asthma. The adjusted HR for asthma was 1.78 times higher in children with croup living in urban areas than in those living in rural areas. In conclusion, our analyses indicated that sex, age, bronchiolitis, and urbanization level are significantly associated with croup and asthma development. According to our cumulative hazard rate curves, younger children with croup should be closely monitored for asthma development for at least 3 years.
哮喘和哮吼是儿童常见的累及支气管的炎症性气道疾病。然而，尚无研究报道城市化、性别、年龄和细支气管炎对哮吼及其病程与哮喘发生之间关联的影响。我们利用台湾纵向健康保险数据库（LHID）开展了这项基于人群的队列研究；在此，考虑了住院引起的聚类效应，以评估哮吼与哮喘发生之间的关联以及不同年龄组儿童哮喘的危险因素。我们在住院聚类中使用Cox比例风险回归分析，对12岁以下的哮吼患儿（n = 1204）和年龄匹配的对照患者（n = 140,887）进行了评估。在所有142,091名患者中，5799人（包括155名哮吼患儿[每1000人年419例]和5644名对照患者[每1000人年106例]）在5年随访期内患有哮喘。在5年随访期内，所有哮吼患儿哮喘的风险比（HRs[95%CI]）为2.10（1.81 - 2.44），0至5岁患儿为2.13（1.85 - 2.46），6至12岁患儿为2.22（1.87 - 2.65）。7至9岁的哮吼患儿哮喘的HR高于其他年龄组。患哮吼的男孩哮喘的HR更高。居住在城市地区的哮吼患儿哮喘的校正HR比居住在农村地区的患儿高1.78倍。总之，我们的分析表明，性别、年龄、细支气管炎和城市化水平与哮吼和哮喘的发生显著相关。根据我们的累积风险率曲线，应密切监测年龄较小的哮吼患儿至少3年的哮喘发生情况。
