Cao Suzhen, Wen Dongsen, Li Sai, Guo Qian, Duan Xiaoli, Gong Jicheng, Xu Xiangyu, Meng Xin, Qin Ning, Wang Beibei, 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.
Beijing Innovation Center for Engineering Science and Advanced Technology, State Key Joint Laboratory for Environmental Simulation and Pollution Control, College of Environmental Sciences and Engineering, And Center for Environment and Health, Peking University, Beijing, China.
J Thorac Dis. 2021 Jul;13(7):4601-4613. doi: 10.21037/jtd-21-158.
It is important to identify risk and beneficial factors for children's lung function. This study aims to ascertain potential changes in children's lung function in relation to changes in socioeconomic, parental and household factors, based on a comparison between two periods spanning 25 years in Wuhan, the largest metropolis in central China.
In two cross-sectional studies, lung function measurements and questionnaire surveys were conducted on school-age children in 1993-1996 (Period I) and in 2018 (Period II). Children of 6-12 years old from elementary schools were selected by a multistage sampling method. Demographic information, socioeconomic status, feeding methods, parental illness and behavior patterns, as well as household characteristics, were collected through a questionnaire survey. Spirometric lung function was measured, including forced vital capacity (FVC), forced expiratory volume in the first second (FEV), forced expiratory flow at 25% and 75% of the pulmonary volume (FEF25-75), and peak expiratory flow (PEF). Wilcoxon analysis of variances was used to assess the differences in lung function indexes between Period I and Period II. Multiple linear regression models were used to estimate the association of lung function with regard to socioeconomic, parental and household factors, respectively.
Significant prevalence reductions were observed for household coal use, paternal smoking and maternal asthma, while the prevalence increased significantly for children sleeping in their own rooms or own beds and breastfeeding, ventilation use during cooking, and parental education level from Period I to Period II. When adjusted for age, height, weight, sex and other factors assessed in the study, children had significant lower values of FVC, FEV, and PEF in Period II than in Period I. Enclosed kitchen was significantly associated with lower lung function in children in Period I. Urban living condition and higher maternal education level were each associated with a higher FVC, while father having no fixed income was associated with a lower FVC and a lower FEV, respectively, in Period II. In comparison with Period I, the beneficial impact of urban living and that of breastfeeding were enhanced and the detrimental effect of poor household condition was weakened in Period II.
Lung function was lower in 2018 than in 1993-1996 in school-age children living in Wuhan. Although improvements in urban living and household environmental conditions as well as increased breastfeeding in Period II could have contributed to increased lung function, other unmeasured risk factors may have played a more dominant role in leading to a net decrease in lung function from Period I to Period II. Future studies are needed to identify these risk factors.
识别儿童肺功能的风险因素和有益因素很重要。本研究旨在基于对中国中部最大城市武汉25年间两个时期的比较，确定儿童肺功能相对于社会经济、父母及家庭因素变化的潜在改变。
在两项横断面研究中，于1993 - 1996年（第一期）和2018年（第二期）对学龄儿童进行了肺功能测量和问卷调查。通过多阶段抽样方法选取小学6 - 12岁的儿童。通过问卷调查收集人口统计学信息、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。测量了肺功能的肺活量测定指标，包括用力肺活量（FVC）、第1秒用力呼气容积（FEV）、肺容积25%和75%时的用力呼气流量（FEF25 - 75）以及呼气峰值流量（PEF）。采用Wilcoxon方差分析评估第一期和第二期之间肺功能指标的差异。分别使用多元线性回归模型估计肺功能与社会经济、父母及家庭因素的关联。
观察到家庭燃煤使用、父亲吸烟和母亲哮喘的患病率显著降低，而从第一期到第二期，儿童独自睡在自己房间或床上、母乳喂养、烹饪时使用通风设备以及父母教育水平的患病率显著增加。在对研究中评估的年龄、身高、体重、性别和其他因素进行调整后，第二期儿童的FVC、FEV和PEF值显著低于第一期。在第一期，封闭式厨房与儿童较低的肺功能显著相关。在第二期，城市生活条件和较高的母亲教育水平分别与较高的FVC相关，而父亲没有固定收入分别与较低的FVC和较低的FEV相关。与第一期相比，第二期城市生活和母乳喂养的有益影响增强，家庭条件差的有害影响减弱。
2018年居住在武汉的学龄儿童的肺功能低于1993 - 1996年。尽管第二期城市生活和家庭环境条件的改善以及母乳喂养的增加可能有助于肺功能的提高，但其他未测量的风险因素可能在导致从第一期到第二期肺功能净下降方面发挥了更主导的作用。未来需要进行研究以识别这些风险因素。
