Li Yueyue, Huang Xin, Liu Qin, Li Wenyan, Yang Bo, Chen Yiwen, Lin Weiwei, Zhang Junfeng Jim
School of Public Health and Management, Research Center for Medicine and Social Development, Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing, China.
School of Public Health, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Sun Yat-sen University, Guangzhou, China.
J Thorac Dis. 2020 Oct;12(10):6356-6364. doi: 10.21037/jtd-19-crh-aq-005.
Respiratory morbidity and mortality during childhood remains a major challenge for global health. Due to the rapid economic development in Chongqing, we expect substantial temporal changes in respiratory health status and environmental risk factors in children. By leveraging a historical dataset, this study aims to assess the changes in prevalence of respiratory symptoms and diseases, residential exposure factors, and their associations in school-age children over a period of 25 years.
This study involved two cross-sectional surveys conducted in Chongqing with a 25-year interval (2017 1993). Purpose sampling was used to conduct questionnaire surveys on school-age children in both surveys. Information collected include children's respiratory health outcomes, family residential exposures, demographic information, and parental respiratory disease history. The changes of residential exposures as well as demographics were determined by chi-square test. Odds ratios were calculated to compare the prevalence of children's respiratory symptoms and diseases between the two periods. Associations between children's respiratory outcomes and exposure indicators were assessed using multivariate logistic regressions.
The majority of residential exposure indicators improved in 2017, including sleep in shared room, cooking with coal, poor kitchen ventilation, cooking frequency, and parental smoking. Compared to the 1993 study, the adjusted risk for children's wheezing was lower (OR: 0.38, 95% CI: 0.29, 0.49), but the risk for bronchitis was higher (OR: 1.89, 95% CI: 1.54, 2.31) in the 2017 study. Poor kitchen ventilation and parental smoking were linked to an increased risk of children's wheezing (OR: 1.39, 95% CI: 1.02, 1.90) and bronchitis (OR: 1.51, 95% CI: 1.02, 2.21), respectively, while heating in winter was linked to an increased risk of phlegm (OR: 1.40, 95% CI: 1.03, 1.90) and wheezing (OR: 1.47, 95% CI: 1.07, 2.01) in the 1993 study. However, these residential exposure factors were no longer associated with the children's respiratory diseases in the 2017 study.
Our study found improvement of residential exposures in Chongqing, a decline of prevalence of children's wheezing but an increase of that of bronchitis from 1993 to 2017. Poor kitchen ventilation, heating in winter, and parental smoking were significant risk factors in the 1993 survey but, with significantly reduced prevalence in 2017, were not significantly associated with children's respiratory morbidity in the latter survey.
儿童期的呼吸道发病和死亡仍是全球健康面临的重大挑战。由于重庆经济的快速发展，我们预计儿童的呼吸道健康状况和环境风险因素会发生显著的时间变化。通过利用一个历史数据集，本研究旨在评估25年间学龄儿童呼吸道症状和疾病的患病率变化、居住暴露因素及其关联。
本研究涉及在重庆进行的两次间隔25年（2017年和1993年）的横断面调查。两次调查均采用目的抽样法对学龄儿童进行问卷调查。收集的信息包括儿童的呼吸道健康结果、家庭居住暴露情况、人口统计学信息以及父母的呼吸道疾病史。居住暴露情况和人口统计学的变化通过卡方检验确定。计算比值比以比较两个时期儿童呼吸道症状和疾病的患病率。使用多因素逻辑回归评估儿童呼吸道结果与暴露指标之间的关联。
2017年大多数居住暴露指标有所改善，包括合住房间睡觉、用煤做饭、厨房通风不良、做饭频率以及父母吸烟。与1993年的研究相比，2017年研究中儿童喘息的校正风险较低（比值比：0.38，95%置信区间：0.29，0.49），但支气管炎的风险较高（比值比：1.89，95%置信区间：1.54，2.31）。厨房通风不良和父母吸烟分别与儿童喘息（比值比：1.39，95%置信区间：1.02，1.90）和支气管炎（比值比：1.51，95%置信区间：1.02，2.21）的风险增加有关，而在1993年的研究中，冬季取暖与咳痰（比值比：1.40，95%置信区间：1.03，1.90）和喘息（比值比：1.47，95%置信区间：1.07，2.01）的风险增加有关。然而，在2017年的研究中，这些居住暴露因素与儿童呼吸道疾病不再相关。
我们的研究发现重庆的居住暴露情况有所改善，1993年至2017年儿童喘息患病率下降但支气管炎患病率上升。厨房通风不良、冬季取暖和父母吸烟在1993年的调查中是重要风险因素，但在2017年患病率显著降低，在后者的调查中与儿童呼吸道发病无显著关联。
