Li Lok Sze Katrina, Williams Marie T, Johnston Kylie N, Frith Peter, Hyppönen Elina, Paquet Catherine
School of Health Sciences, University of South Australia, Adelaide, Australia.
College of Medicine and Public Health, Flinders University, Adelaide, Australia.
ERJ Open Res. 2020 Mar 2;6(1). doi: 10.1183/23120541.00343-2019. eCollection 2020 Jan.
Few studies have examined the contribution of life-course factors in explaining familial aggregation of chronic lung conditions. Using data from the 1958 British Birth Cohort, a life-course approach was used to examine whether, and how, exposure to risk factors through one's life explained the association between parental respiratory disease history and symptomatic airflow obstruction (AO). Cohort participants (n=6212) were characterised in terms of parental respiratory disease history and symptomatic AO at 45 years. Life-course factors ( smoking, asthma and early-life factors) were operationalised as life period-specific and cumulative measures. Logistic regression and path analytic models predicting symptomatic AO adjusted for parental respiratory disease history were used to test different life-course models (critical period, accumulation- and chain-of-risks models). While some life-course factors ( childhood passive smoking and occupational exposure) were individually associated with parental respiratory disease history and symptomatic AO, asthma (OR 6.44, 95% CI 5.01-8.27) and persistent smoking in adulthood (OR 5.42, 95% CI 4.19-7.01) had greater impact on the association between parental respiratory disease history and symptomatic AO. A critical period model provided a better model fit compared with an accumulation-of-risk model and explained 57% of the effect of parental respiratory disease history on symptomatic AO. Adulthood asthma and smoking status explained around half of the effect of parental respiratory disease history on chronic obstructive pulmonary disease. Beyond smoking history, the combination of parental respiratory disease history and adulthood asthma may provide an opportunity for early diagnosis and intervention.
很少有研究探讨生命历程因素在解释慢性肺部疾病家族聚集性方面的作用。利用1958年英国出生队列的数据，采用生命历程方法来研究一生中暴露于风险因素是否以及如何解释父母呼吸系统疾病史与症状性气流受限（AO）之间的关联。队列参与者（n = 6212）根据45岁时父母的呼吸系统疾病史和症状性AO进行特征描述。生命历程因素（吸烟、哮喘和早期生活因素）被作为特定生命时期和累积指标来操作化。使用针对父母呼吸系统疾病史进行调整的逻辑回归和路径分析模型来预测症状性AO，以检验不同的生命历程模型（关键时期模型、累积风险模型和风险链模型）。虽然一些生命历程因素（儿童期被动吸烟和职业暴露）分别与父母呼吸系统疾病史和症状性AO相关，但哮喘（比值比6.44，95%置信区间5.01 - 8.27）和成年期持续吸烟（比值比5.42，95%置信区间4.19 - 7.01）对父母呼吸系统疾病史与症状性AO之间的关联影响更大。与累积风险模型相比，关键时期模型提供了更好的模型拟合，并且解释了父母呼吸系统疾病史对症状性AO影响的57%。成年期哮喘和吸烟状况解释了父母呼吸系统疾病史对慢性阻塞性肺疾病影响的大约一半。除吸烟史外，父母呼吸系统疾病史与成年期哮喘的组合可能为早期诊断和干预提供机会。
