1 Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; and.
2 Clinical Epidemiology and Health Services Research.
Ann Am Thorac Soc. 2018 Jun;15(6):728-734. doi: 10.1513/AnnalsATS.201708-693OC.
Childhood asthma has shown variable associations with children's physical activity. Neighborhood walkability captures community features that promote walking and is protective against some chronic conditions, such as obesity and diabetes.
We evaluated associations between home neighborhood walkability and incident and ongoing childhood asthma.
In this population-based cohort study, we used prospectively collected administrative healthcare data for the Province of Ontario housed at the Institute for Clinical Evaluative Sciences. We followed an administrative data cohort of 326,383 Toronto children born between 1997 and 2003, inclusive, until ages 8-15 years. Home neighborhood walkability quintile was measured using a validated walkability index with four dimensions: population density, dwelling density, access to retail and services, and street connectivity. Incident asthma was defined by time of entry into the validated Ontario Asthma Surveillance Information System database, which requires two outpatient visits for asthma within two consecutive years or any hospitalization for asthma and follows children with asthma longitudinally starting at any age. Associations between walkability and incident asthma were examined using Cox proportional hazards models. Associations between ongoing asthma and walkability in each year of life were examined using generalized linear mixed models.
Twenty-one percent of children (n = 69,628) developed incident asthma and were followed longitudinally in the Ontario Asthma Surveillance Information System database. Low birth home neighborhood walkability was associated with an increased incidence of asthma (hazard ratio, 1.11; 95% confidence interval, 1.08-1.14). Among children with asthma, low walkability in a given year of a child`s life was associated with greater odds of ongoing asthma in the same year (odds ratio, 1.12; 95% confidence interval, 1.09-1.14).
Children living in neighborhoods with low walkability were at increased risk of incident and ongoing asthma. Neighborhood walkability improvement, such as by adding pedestrian paths to improve street connectivity, offers potential strategies to contribute to primary asthma prevention.
儿童哮喘与儿童身体活动之间的关系存在差异。社区步行环境可反映促进步行的社区特征，并且可以预防肥胖和糖尿病等一些慢性疾病。
我们评估了家庭社区步行环境与儿童哮喘发病和持续存在之间的关系。
在这项基于人群的队列研究中，我们使用安大略省研究所临床评估科学收集的前瞻性行政医疗保健数据。我们对 1997 年至 2003 年出生的 326383 名多伦多儿童进行了行政数据队列随访，随访至 8-15 岁。使用验证的步行环境指数，通过四个维度衡量家庭社区步行环境的五分位数：人口密度、住宅密度、零售和服务可达性以及街道连通性。通过验证的安大略省哮喘监测信息系统数据库的进入时间定义哮喘发病，该数据库需要在两年内两次门诊就诊才能确诊哮喘，或因哮喘住院，并且在任何年龄段开始对哮喘儿童进行长期随访。使用 Cox 比例风险模型检验步行环境与哮喘发病之间的关系。使用广义线性混合模型检验每年哮喘发病与步行环境之间的关系。
21%的儿童（n=69628）患有哮喘发病，并在安大略省哮喘监测信息系统数据库中进行了纵向随访。低出生家庭社区步行环境与哮喘发病风险增加相关（风险比，1.11；95%置信区间，1.08-1.14）。在患有哮喘的儿童中，儿童生命中某一年的低步行环境与同年持续哮喘的可能性更大相关（比值比，1.12；95%置信区间，1.09-1.14）。
生活在步行环境较差的社区的儿童哮喘发病和持续存在的风险增加。改善社区步行环境，例如增加步行道以改善街道连通性，为预防哮喘提供了潜在的策略。
