社区儿童人口密度作为生命第一年呼吸道感染暴露的替代测量指标：一项验证研究。
Neighbourhood child population density as a proxy measure for exposure to respiratory infections in the first year of life: A validation study.
机构信息
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Institute of Pharmaceutical Medicine, University of Basel, Basel Switzerland.
出版信息
PLoS One. 2018 Sep 12;13(9):e0203743. doi: 10.1371/journal.pone.0203743. eCollection 2018.
BACKGROUND
Assessing exposure to infections in early childhood is of interest in many epidemiological investigations. Because exposure to infections is difficult to measure directly, epidemiological studies have used surrogate measures available from routine data such as birth order and population density. However, the association between population density and exposure to infections is unclear. We assessed whether neighbourhood child population density is associated with respiratory infections in infants.
METHODS
With the Basel-Bern lung infant development study (BILD), a prospective Swiss cohort study of healthy neonates, respiratory symptoms and infections were assessed by weekly telephone interviews with the mother throughout the first year of life. Using population census data, we calculated neighbourhood child density as the number of children < 16 years of age living within a 250 m radius around the residence of each child. We used negative binomial regression models to assess associations between neighbourhood child density and the number of weeks with respiratory infections and adjusted for potential confounders including the number of older siblings, day-care attendance and duration of breastfeeding. We investigated possible interactions between neighbourhood child population density and older siblings assuming that older siblings mix with other children in the neighbourhood.
RESULTS
The analyses included 487 infants. We found no evidence of an association between quintiles of neighbourhood child density and number of respiratory symptoms (p = 0.59, incidence rate ratios comparing highest to lowest quintile: 1.15, 95%-confidence interval: 0.90-1.47). There was no evidence of interaction with older siblings (p = 0.44). Results were similar in crude and in fully adjusted models.
CONCLUSIONS
Our study suggests that in Switzerland neighbourhood child density is a poor proxy for exposure to infections in infancy.
背景
在许多流行病学研究中，评估儿童早期的感染暴露情况很有意义。由于感染暴露难以直接测量，因此流行病学研究使用了来自常规数据的替代指标，例如出生顺序和人口密度。但是，人口密度与感染暴露之间的关联尚不清楚。我们评估了邻里儿童人口密度与婴儿呼吸道感染之间的关系。
方法
我们采用巴塞尔-伯尔尼肺婴儿发育研究（BILD），这是一项针对健康新生儿的前瞻性瑞士队列研究，通过母亲每周一次的电话访谈来评估婴儿在第一年中的呼吸症状和感染情况。我们使用人口普查数据，计算了邻里儿童密度，即居住在每个儿童住所周围 250 米半径范围内的<16 岁儿童人数。我们使用负二项回归模型来评估邻里儿童密度与呼吸道感染周数之间的关联，并调整了潜在的混杂因素，包括年龄较大的兄弟姐妹数量、日托出勤率和母乳喂养时间。我们还研究了邻里儿童人口密度与年龄较大的兄弟姐妹之间可能存在的相互作用，假设年龄较大的兄弟姐妹会与邻里中的其他孩子混合。
结果
该分析包括 487 名婴儿。我们没有发现邻里儿童密度五分位数与呼吸道症状数量之间存在关联（p=0.59，比较最高五分位与最低五分位的发病率比：1.15，95%置信区间：0.90-1.47）。没有证据表明与年龄较大的兄弟姐妹之间存在交互作用（p=0.44）。在原始模型和完全调整模型中，结果均相似。
结论
我们的研究表明，在瑞士，邻里儿童密度是婴儿感染暴露的一个较差的替代指标。
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