Baard Cynthia B, Franckling-Smith Zoe, Munro Jacinta, Workman Lesley, Zar Heather J
University of Cape Town, Dept of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and the SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
ERJ Open Res. 2021 Apr 6;7(2). doi: 10.1183/23120541.00576-2020. eCollection 2021 Apr.
South Africa has undergone major economic and health system changes, impacting the epidemiology of childhood asthma. This study aimed to investigate prevalence time trends of asthma in South African adolescents over two decades and to identify associated risk factors.
A cross-sectional survey was conducted in 2017, in a randomised sample of 13-14-year-old Cape Town adolescents, using the standardised Global Asthma Network written, video and environmental questionnaires. Using time-trend analysis, the prevalence and severity of asthma were compared with data from the 2002 ISAAC phase III study. Environmental and social risk factors were analysed.
A total of 3979 adolescents were included. The prevalence of lifetime and current asthma were 34.5% and 21.3%, respectively, on the self-report written questionnaire, similar to 2002 results. The prevalence of severe asthma in the previous 12 months increased, measured by wheeze limiting speech (7.8% to 11.8%), four or more attacks of wheezing (5.0% to 5.8%) or woken by wheeze on one or more nights per week (5.0% to 6.9%). The video questionnaire revealed increases in lifetime (16.9% to 22.5%), current (11.2% to 18.7%) and severe asthma (12.1% to 14.8%). Multivariate analysis showed associations between current asthma and smoking, female sex, pet exposure and higher socioeconomic status. Severe asthma was associated with smoking, pet exposure, outdoor pollution exposure and informal housing; 33% of those with severe or current asthma had been diagnosed.
The prevalence of asthma is high, with increasing rates of severe asthma in adolescents. Underdiagnosis is a major concern and reduction in exposure to environmental factors, particularly smoking, and improved socioeconomic development are needed.
南非经历了重大的经济和卫生系统变革，这对儿童哮喘的流行病学产生了影响。本研究旨在调查二十多年来南非青少年哮喘患病率的时间趋势，并确定相关风险因素。
2017年对开普敦13 - 14岁青少年的随机样本进行了横断面调查，使用标准化的全球哮喘网络书面、视频和环境问卷。通过时间趋势分析，将哮喘的患病率和严重程度与2002年国际儿童哮喘和过敏研究（ISAAC）第三阶段研究的数据进行比较。分析了环境和社会风险因素。
共纳入3979名青少年。根据自我报告书面问卷，终生哮喘患病率和当前哮喘患病率分别为34.5%和21.3%，与2002年的结果相似。通过喘息限制言语（从7.8%增至11.8%）、四次或更多次喘息发作（从5.0%增至5.8%）或每周一个或多个晚上因喘息醒来（从5.0%增至6.9%）衡量，过去12个月中重度哮喘患病率有所增加。视频问卷显示终生哮喘（从16.9%增至22.5%）、当前哮喘（从11.2%增至18.7%）和重度哮喘（从12.1%增至14.8%）患病率均增加。多变量分析显示当前哮喘与吸烟、女性性别、宠物接触和较高的社会经济地位之间存在关联。重度哮喘与吸烟、宠物接触、室外污染暴露和非正规住房有关；33%的重度或当前哮喘患者已被诊断。
哮喘患病率很高，青少年重度哮喘患病率呈上升趋势。诊断不足是一个主要问题，需要减少环境因素暴露，特别是吸烟，并改善社会经济发展。
