Rutter Charlotte E, Silverwood Richard J, Asher M Innes, Ellwood Philippa, Pearce Neil, Garcia-Marcos Luis, Strachan David P
Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Centre for Longitudinal Studies, Department of Social Science, University College London, London, United Kingdom.
World Allergy Organ J. 2020 Jul 2;13(6):100123. doi: 10.1016/j.waojou.2020.100123. eCollection 2020 Jun.
Symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema in children cluster at both the individual and population levels.
To assess individual-level and school-level risk factors for symptoms of rhinoconjunctivitis and compare them to corresponding associations with symptoms of asthma and eczema in Phase Three of the International Study of Asthma and Allergies in Childhood.
We studied 116,863 children aged 6-7 years from 2163 schools in 59 centres and 22 countries and 224,436 adolescents aged 13-14 years from 2037 schools in 97 centres in 41 countries. Multilevel logistic regression models were fitted with random intercepts for school, centre, and country, adjusting for sex and maternal education at the child level. Associations between symptoms and a range of lifestyle and environmental risk factors were assessed for both the child's exposure and mean exposure at the school. Models were fitted for rhinoconjunctivitis, asthma, and eczema singly (unimorbidity) and for combinations of these conditions (multimorbidity).
Generally, associations between symptoms and exposures at the school level were similar in direction and magnitude to those at the child level. Associations with multimorbidity were stronger than for unimorbidity, particularly in individuals with symptoms of all three diseases, but risk factor associations found in conventional single disease analyses persisted among children with only one condition, after excluding multimorbid groups.Comparisons of individuals with only one disease showed that many risk factor associations were consistent across the three conditions. More strongly associated with asthma were low birthweight, cat exposure in infancy, and current maternal smoking. Current paracetamol use was more strongly associated with asthma and rhinoconjunctivitis than eczema. Breastfeeding was more strongly associated with eczema than asthma or rhinoconjunctivitis.The direction and magnitude of most risk factor associations were similar in affluent and non-affluent countries, although notable exceptions include farm animal contact in infancy and larger sibships, which were associated with increased risk of rhinoconjunctivitis in non-affluent countries but reduced risk in affluent countries. In both age groups, current paracetamol use increased risk of each disease to a greater extent in affluent countries than in non-affluent countries. Effects of paracetamol and antibiotics in infancy were more consistent between richer and poorer settings.
Most of the environmental and lifestyle correlates of rhinoconjunctivitis, asthma and eczema in childhood display similarity across the three conditions, even in less affluent settings where allergic sensitisation is less likely to explain the concordant epidemiological patterns.
Not applicable.
儿童哮喘、过敏性鼻结膜炎和特应性皮炎的症状在个体和人群层面上都有聚集现象。
在儿童哮喘和过敏国际研究的第三阶段，评估鼻结膜炎症状的个体层面和学校层面的危险因素，并将其与哮喘和湿疹症状的相应关联进行比较。
我们研究了来自59个中心22个国家2163所学校的116863名6-7岁儿童，以及来自41个国家97个中心2037所学校的224436名13-14岁青少年。采用多水平逻辑回归模型，对学校、中心和国家进行随机截距分析，并在儿童层面上对性别和母亲教育程度进行调整。评估了症状与一系列生活方式和环境危险因素之间的关联，包括儿童的暴露情况和学校的平均暴露情况。分别针对鼻结膜炎、哮喘和湿疹（单一疾病）以及这些疾病的组合（多种疾病）建立模型。
一般来说，学校层面的症状与暴露之间的关联在方向和程度上与儿童层面相似。与多种疾病的关联比单一疾病更强，特别是在患有所有三种疾病症状的个体中，但在排除多种疾病组后，传统单一疾病分析中发现的危险因素关联在仅患一种疾病的儿童中仍然存在。对仅患一种疾病的个体进行比较发现，许多危险因素关联在这三种疾病中是一致的。与哮喘关联更强的因素包括低出生体重、婴儿期接触猫以及母亲目前吸烟。目前使用对乙酰氨基酚与哮喘和鼻结膜炎的关联比对特性皮炎更强。母乳喂养与特应性皮炎的关联比与哮喘或鼻结膜炎更强。富裕国家和非富裕国家中大多数危险因素关联的方向和程度相似，尽管明显的例外包括婴儿期接触农场动物和较大的家庭规模，在非富裕国家这些因素与鼻结膜炎风险增加有关，而在富裕国家则与风险降低有关。在两个年龄组中，目前使用对乙酰氨基酚在富裕国家比在非富裕国家更能增加每种疾病的风险。在较富裕和较贫困地区，婴儿期使用对乙酰氨基酚和抗生素的影响更为一致。
儿童鼻结膜炎、哮喘和湿疹的大多数环境和生活方式相关因素在这三种疾病中表现出相似性，即使在过敏致敏不太可能解释一致的流行病学模式的较不富裕环境中也是如此。
不适用。
