Cao Suzhen, Wen Dongsen, Li Sai, Duan Xiaoli, Zhang Yaqun, Gong Jicheng, Guo Qian, Xu Xiangyu, Qin Ning, Meng Xin, Zhang Junfeng Jim
Beijing Key Laboratory of Resource-oriented Treatment of Industrial Pollutants, School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing, China.
Gansu Provincial Design and Research Institute of Environmental Science, Lanzhou, China.
J Thorac Dis. 2020 Oct;12(10):6365-6378. doi: 10.21037/jtd-19-crh-aq-008.
The prevalence of childhood asthma may have changed with rapid economic development. This study aims to ascertain potential changes in asthma prevalence in relation to changes in socioeconomic, parental and household factors, based on a comparison between two periods spanning over 20 years in Lanzhou, a large northwestern city of China.
Cross-sectional studies using the same protocols were performed in Lanzhou, China in 1994-1995 (Period I) and in 2017 (Period II). Children of 6-12 years old from elementary schools were selected by a multistage sampling method. Information on the presence of asthma and asthma-related symptoms of children, socioeconomic status, feeding methods, parental illness and behavior patterns, as well as household characteristics, were collected through a questionnaire survey. Logistic regression models were used to estimate odds ratios of asthma prevalence with regard to socioeconomic, parental and household factors, respectively.
Significant prevalence reductions were observed for paternal smoking, household coal use, and parental asthma, while the prevalence increased significantly for children sleeping in their own rooms or own beds, ventilation use during cooking, and parental occupation and education level after 22 years. In children, the prevalence of ever-diagnosed asthma decreased from 3.2% in period I to 1.5% in Period II (P<0.001); the prevalence of wheeze also decreased from 15.4% to 9.3% (P<0.001). Passive smoking (OR =1.531, 95% CI: 1.032-2.270) and poor household ventilation (OR =1.709, 95% CI: 1.208-2.416) were significantly associated with an increased prevalence of wheeze in Period I, whereas household mold (OR =2.112, 95% CI: 1.203-3.811) was significantly associated with prevalence of wheeze. Parental asthma history was associated with increased prevalence of asthma and asthma-related symptoms. Breastfeeding was significantly associated with reduced risk of asthma in period II children.
The prevalence of asthma and that of asthma-related symptoms were lower in 2017 than in 1994-1995 in school children living in Lanzhou. In 2017 with increased urbanization and industrialization, breastfeeding became a significant protective factor and household mold was a significant risk factor for asthma diagnosis and asthma-related symptoms. Promoting breastfeeding and household mold control is recommended to reduce the risk of childhood asthma in contemporary Lanzhou.
随着经济的快速发展，儿童哮喘的患病率可能已发生变化。本研究旨在通过比较中国西北大城市兰州20多年间的两个时期，确定哮喘患病率与社会经济、父母及家庭因素变化相关的潜在变化情况。
1994 - 1995年（第一阶段）和2017年（第二阶段）在中国兰州采用相同方案进行横断面研究。通过多阶段抽样方法选取小学6 - 12岁的儿童。通过问卷调查收集有关儿童哮喘及哮喘相关症状的存在情况、社会经济状况、喂养方式、父母疾病及行为模式以及家庭特征等信息。使用逻辑回归模型分别估计哮喘患病率与社会经济、父母及家庭因素相关的比值比。
观察到父亲吸烟、家庭使用煤炭以及父母哮喘的患病率显著降低，而22年后儿童独自睡在自己房间或床上、烹饪时使用通风设备以及父母职业和教育水平的患病率显著增加。在儿童中，曾被诊断为哮喘的患病率从第一阶段的3.2%降至第二阶段的1.5%（P<0.001）；喘息患病率也从15.4%降至9.3%（P<0.001）。被动吸烟（OR =1.531，95%CI：1.032 - 2.270）和家庭通风不良（OR =1.709，95%CI：1.208 - 2.416）在第一阶段与喘息患病率增加显著相关，而家庭霉菌（OR =2.112，95%CI：1.203 - 3.811）与喘息患病率显著相关。父母哮喘病史与哮喘及哮喘相关症状的患病率增加相关。母乳喂养与第二阶段儿童哮喘风险降低显著相关。
2017年兰州学龄儿童哮喘及哮喘相关症状的患病率低于1994 - 1995年。在2017年，随着城市化和工业化的增加，母乳喂养成为一个显著的保护因素，而家庭霉菌是哮喘诊断及哮喘相关症状的一个显著风险因素。建议推广母乳喂养和控制家庭霉菌以降低当代兰州儿童哮喘的风险。
