Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstraße 22, 89081, Ulm, Germany.
Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.
Eur J Epidemiol. 2019 May;34(5):509-520. doi: 10.1007/s10654-018-0463-z. Epub 2018 Nov 11.
Asthma prevalence in children varies substantially around the world, but the contribution of known risk factors to this international variation is uncertain. The International Study of Asthma and Allergies in Childhood (ISAAC) Phase Two studied 8-12 year old children in 30 centres worldwide with parent-completed symptom and risk factor questionnaires and aeroallergen skin prick testing. We used multilevel logistic regression modelling to investigate the effect of adjustment for individual and ecological risk factors on the between-centre variation in prevalence of recent wheeze. Adjustment for single individual-level risk factors changed the centre-level variation from a reduction of up to 8.4% (and 8.5% for atopy) to an increase of up to 6.8%. Modelling the 11 most influential environmental factors among all children simultaneously, the centre-level variation changed little overall (2.4% increase). Modelling only factors that decreased the variance, the 6 most influential factors (synthetic and feather quilt, mother's smoking, heating stoves, dampness and foam pillows) in combination resulted in a 21% reduction in variance. Ecological (centre-level) risk factors generally explained higher proportions of the variation than did individual risk factors. Single environmental factors and aeroallergen sensitisation measured at the individual (child) level did not explain much of the between-centre variation in wheeze prevalence.
儿童哮喘的患病率在全球范围内存在很大差异，但已知风险因素对这种国际差异的贡献尚不确定。国际儿童哮喘和过敏研究（ISAAC）第二阶段在全球 30 个中心对 8-12 岁儿童进行了研究，采用家长完成的症状和风险因素问卷以及变应原皮肤点刺试验。我们使用多水平逻辑回归模型研究了调整个体和生态风险因素对近期喘息患病率的中心间差异的影响。调整单个个体水平风险因素后，中心水平的变异从最多减少 8.4%（特应性为 8.5%）变为最多增加 6.8%。对所有儿童的所有 11 个最具影响力的环境因素进行建模，总体上中心水平的变异变化不大（增加 2.4%）。仅对降低方差的因素进行建模，6 个最具影响力的因素（合成和羽毛被、母亲吸烟、取暖炉、潮湿和泡沫枕头）结合起来导致方差减少 21%。生态（中心水平）风险因素通常比个体风险因素解释更多的变异。在个体（儿童）水平测量的单个环境因素和变应原致敏并不能解释喘息患病率的中心间差异的大部分。
