Ren Jie, Xu Jing, Zhang Pingbo, Bao Yixiao
Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Yangpu District Maternity and Child Healthcare Hospital, Shanghai, China.
Front Pediatr. 2022 Feb 9;9:793452. doi: 10.3389/fped.2021.793452. eCollection 2021.
Previous studies have shown the increasing prevalence of childhood asthma around the world as well as in China. Nevertheless, little is known about the epidemiology of asthma in preschool children. Thus, the present study investigated the prevalence and severity of asthma in Shanghai, China, and identified related risk factors for asthma in children at the age of 3-6.
Information was obtained through the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Risk factor analysis was carried out using univariate and multivariate logistic regression. The odds ratio (OR)/adjusted odds ratio (aOR) and the 95% confidence interval (CI) were determined.
A total of 6,183 children (3,165 boys and 3,018 girls) covering 12 communities were included in our study, with an average age of 4.2 ± 0.7 years. The prevalence of ever asthma, current asthma, and physician-diagnosed asthma was 16.0, 11.2, and 5.3%, respectively. Parental allergic history, including rhinitis and asthma, was significantly associated with asthma symptoms. The strongest association with current asthma was paternal asthma (aOR = 5.91, 95% CI 3.87-9.01), and maternal asthma had the second strongest association with current asthma (3.85; 2.40-6.17). Among personal factors, allergic rhinitis history, eczema history, food allergy history, and antibiotic use in the first year of life were significantly associated with current asthma (aOR = 1.89, 95% CI 1.52-2.34; aOR = 1.34, 95% CI 1.09-1.64; aOR = 1.68, 95% CI 1.37-2.06; aOR = 1.53, 95% CI 1.25-1.87, respectively). More than once paracetamol use per year and per month were associated with current asthma in a dose-response manner. Additionally, female sex was an independent protective factor for ever asthma (0.82; 0.70-0.96). Among environmental factors, dampness or mildew at home was an independent risk factor for ever asthma (1.50; 1.15-1.97) and current asthma (1.63; 1.21-2.19). Floor heating system was significantly associated with ever asthma (1.57; 1.25-1.98) and current asthma (1.36; 1.04-1.78). Furthermore, dampness or mildew, infrequent house cleaning, and truck traffic in residential streets were significantly associated with asthma symptoms only in old communities, while paracetamol use in the first year of life and flooring materials were significant factors only in new communities.
The prevalence of asthma has increased among preschool children in Shanghai over the past three decades. The identified risk factors indicated the combined effects of genetic, personal, and environmental factors on asthma symptoms. Differentiated strategies should be taken for preventing asthma in old and new communities.
先前的研究表明，全球以及中国儿童哮喘的患病率都在上升。然而，关于学龄前儿童哮喘的流行病学情况却知之甚少。因此，本研究调查了中国上海哮喘的患病率和严重程度，并确定了3至6岁儿童哮喘的相关危险因素。
通过儿童哮喘和过敏国际研究（ISAAC）问卷获取信息。使用单因素和多因素逻辑回归进行危险因素分析。确定比值比（OR）/调整后比值比（aOR）以及95%置信区间（CI）。
我们的研究纳入了来自12个社区的6183名儿童（3165名男孩和3018名女孩），平均年龄为4.2±0.7岁。曾患哮喘、当前哮喘和医生诊断哮喘的患病率分别为16.0%、11.2%和5.3%。父母的过敏史，包括鼻炎和哮喘，与哮喘症状显著相关。与当前哮喘关联最强的是父亲患哮喘（aOR = 5.91，95% CI 3.87 - 9.01），母亲患哮喘与当前哮喘的关联次之（3.85；2.40 - 6.17）。在个人因素中，过敏性鼻炎史、湿疹史、食物过敏史以及出生后第一年使用抗生素与当前哮喘显著相关（aOR分别为1.89，95% CI 1.52 - 2.34；aOR = 1.34，95% CI 1.09 - 1.64；aOR = 1.68，95% CI 1.37 - 2.06；aOR = 1.53，95% CI 1.25 - 1.87）。每年和每月不止一次使用对乙酰氨基酚与当前哮喘呈剂量反应关系。此外，女性是曾患哮喘的独立保护因素（0.82；0.70 - 0.96）。在环境因素中，家中潮湿或发霉是曾患哮喘（1.50；1.15 - 1.97）和当前哮喘（1.63；1.21 - 2.19）的独立危险因素。地板供暖系统与曾患哮喘（1.57；1.25 - 1.98）和当前哮喘（1.36；1.04 - 1.78）显著相关。此外，潮湿或发霉、不经常打扫房屋以及住宅街道上的货车交通仅在老社区与哮喘症状显著相关，而出生后第一年使用对乙酰氨基酚和地板材料仅在新社区是显著因素。
在过去三十年中，上海学龄前儿童哮喘的患病率有所上升。已确定的危险因素表明遗传、个人和环境因素对哮喘症状的综合影响。应针对老社区和新社区采取不同的哮喘预防策略。
