Trend of asthma prevalence among children based on regional urbanization level in Japan; 2006-2019.

Although it has been known that the prevalence of asthma tends to be higher among children in the metropolitan areas of Japan, trends of the prevalence with respect to the regional urbanization level has not been investigated in recent years. We investigated trends in the prevalence of asthma among children and air pollutant concentrations by regional urbanization levels using data from the School Health Statistics Survey in Japan from 2006 to 2019. We calculated the age-standardized prevalence of asthma for each year, gender, regional urbanization level, and annual percent change (APC). In addition, the slope index of inequality (SII) and relative index of inequality (RII) were calculated for evaluating disparity in age-standardized asthma prevalence depending on regional urbanization levels. Moreover, we calculated the mean of the annual average values by regional urbanization levels for sulfur dioxide (SO2), nitrogen dioxide (NO2), suspended particulate matter (SPM), carbon monoxide (CO), and photochemical oxidant (Ox) from 2006 to 2018. We found that the age-standardized prevalence significantly decreased in the periods in the metropolis for males and females, and the degree of the decrease was largest in the metropolis. Conversely, the age-standardized prevalence increased in towns and villages, and the APC was greater than zero. In addition, both the SII and RII showed significant decreasing trends in the study period, and the regional disparity shrank over the years. Moreover, concentrations of the air pollutants were highest in the metropolis throughout the years except for Ox, whereas the difference in the concentrations of NO2, SPM, and CO decreased between the metropolis and the other areas over the years. In conclusion, disparity in asthma prevalence depending on regional urbanization level decreased from 2006 to 2019, and there is a possibility that regional difference in trend of the air pollutants is related to the result.