Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
Facultad de Ciencias Médicas de la Salud y la Vida, Universidad Internacional del Ecuador, Quito, Ecuador.
Thorax. 2019 Nov;74(11):1020-1030. doi: 10.1136/thoraxjnl-2018-211793. Epub 2019 Jul 5.
Urbanisation has been associated with temporal and geographical differences in asthma prevalence in low-income and middle-income countries (LMICs). However, little is known of the mechanisms by which urbanisation and asthma are associated, perhaps explained by the methodological approaches used to assess the urbanisation-asthma relationship.
This review evaluated how epidemiological studies have assessed the relationship between asthma and urbanisation in LMICs, and explored urban/rural differences in asthma prevalence.
Asthma studies comparing urban/rural areas, comparing cities and examining intraurban variation were assessed for eligibility. Included publications were evaluated for methodological quality and pooled OR were calculated to indicate the risk of asthma in urban over rural areas.
Seventy articles were included in our analysis. Sixty-three compared asthma prevalence between urban and rural areas, five compared asthma prevalence between cities and two examined intraurban variation in asthma prevalence. Urban residence was associated with a higher prevalence of asthma, regardless of asthma definition: current-wheeze OR:1.46 (95% CI:1.22 to 1.74), doctor diagnosis OR:1.89 (95% CI:1.47 to 2.41), wheeze-ever OR:1.44 (95% CI:1.15 to 1.81), self-reported asthma OR:1.77 (95% CI:1.33 to 2.35), asthma questionnaire OR:1.52 (95% CI:1.06 to 2.16) and exercise challenge OR:1.96 (95% CI:1.32 to 2.91).
Most evidence for the relationship between urbanisation and asthma in LMICs comes from studies comparing urban and rural areas. These studies tend to show a greater prevalence of asthma in urban compared to rural populations. However, these studies have been unable to identify which specific characteristics of the urbanisation process may be responsible. An approach to understand how different dimensions of urbanisation, using contextual household and individual indicators, is needed for a better understanding of how urbanisation affects asthma.
CRD42017064470.
城市化与低收入和中等收入国家（LMICs）哮喘流行的时间和地域差异有关。然而，对于城市化和哮喘之间的关联机制知之甚少，这也许可以用评估城市化与哮喘关系的方法学方法来解释。
本综述评估了流行病学研究如何评估 LMICs 中哮喘与城市化之间的关系，并探讨了城市/农村哮喘患病率的差异。
评估了比较城乡地区、比较城市并检查城市内部变异的哮喘研究的合格性。对纳入的出版物进行了方法学质量评估，并计算了比值比（OR）以表明城市地区哮喘的风险高于农村地区。
我们的分析共纳入了 70 篇文章。63 篇文章比较了城市和农村地区的哮喘患病率，5 篇文章比较了城市之间的哮喘患病率，2 篇文章检查了城市内部哮喘患病率的变化。无论哮喘的定义如何，居住在城市与更高的哮喘患病率相关：当前喘息的 OR：1.46（95%CI：1.22 至 1.74）、医生诊断的 OR：1.89（95%CI：1.47 至 2.41）、曾有喘息的 OR：1.44（95%CI：1.15 至 1.81）、自我报告的哮喘 OR：1.77（95%CI：1.33 至 2.35）、哮喘问卷的 OR：1.52（95%CI：1.06 至 2.16）和运动激发试验的 OR：1.96（95%CI：1.32 至 2.91）。
大多数关于城市化与 LMICs 中哮喘关系的证据来自于比较城市和农村地区的研究。这些研究往往表明，城市人口的哮喘患病率高于农村人口。然而，这些研究尚未能够确定城市化进程的哪些具体特征可能是原因。需要采用一种方法来理解城市化的不同维度，利用背景家庭和个人指标，以更好地了解城市化如何影响哮喘。
PROSPERO 注册号：CRD42017064470。
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