School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Usher Institute, University of Edinburgh, Edinburgh, UK.
J Glob Health. 2022 Jun 29;12:04052. doi: 10.7189/jogh.12.04052.
Asthma has a significant impact on people of all ages, particularly children. A lack of universally accepted case definition and confirmatory tests and a poor understanding of major risks interfere with a global response. We aimed to provide global estimates of asthma prevalence and cases in 2019 across four main epidemiological case definitions - current wheezing, ever wheezing, current asthma, and ever asthma. We further investigated major associated factors to determine regional and national distributions of prevalence and cases for current wheezing and ever asthma.
We identified relevant population-based studies published between January 1, 1990, and December 31, 2019. Using a multilevel multivariable mixed-effects meta-regression model, we assessed the age- and sex-adjusted associations of asthma with study-level variables, including year, setting, region and socio-demographic index (SDI). Using a random-effects meta-analysis, we then identified risk factors for current wheezing and asthma. From a "risk factor-based model", which included current smoking, and biomass exposure for current wheezing, and rural setting, current smoking, biomass exposure, and SDI for ever asthma, we estimated case numbers and prevalence across regions and 201 countries and territories in 2019.
220 population-based studies conducted in 88 countries were retained. In 2019, the global prevalence estimates of asthma in people aged 5-69 years by various definitions, namely current wheezing, ever wheezing, current asthma, and ever asthma were 11.5% (95% confidence interval (CI) = 9.1-14.3), 17.9% (95% CI = 14.2-22.3), 5.4% (95% CI = 3.2-9.0) and 9.8% (95% CI = 7.8-12.2), respectively. These translated to 754.6 million (95% CI = 599. 7-943.4), 1181.3 million (95% CI = 938.0-1,471.0), 357.4 million (95% CI = 213.0-590.8), 645.2 million (95% CI = 513.1-806.2) cases, respectively. The overall prevalence of current wheezing among people aged 5-69 years was the highest in the African Region at 13.2% (95% CI = 10.5-16.5), and the lowest in the Americas Region at 10.0% (95% CI = 8.0-12.5). For ever asthma, the estimated prevalence in those aged 5-69 years was also the highest in the African Region at 11.3% (95% CI = 9.0-14.1), but the lowest in South-East Asia Region (8.8, 95% CI = 7.0-11.0).
Although varying approaches to case identification in different settings make epidemiological estimates of asthma very difficult, this analysis reaffirms asthma as a common global respiratory condition before the COVID-19 pandemic in 2019, with higher prevalence than previously reported in many world settings.
哮喘对各个年龄段的人都有重大影响，尤其是儿童。由于缺乏普遍接受的病例定义和确诊性检测，以及对主要风险因素的认识不足，阻碍了全球的应对措施。我们旨在提供 2019 年全球哮喘发病率和病例的估计数据，涵盖了四个主要的流行病学病例定义——当前喘息、曾经喘息、当前哮喘和曾经哮喘。我们进一步调查了主要相关因素，以确定当前喘息和曾经哮喘的发病率和病例在各地区和国家的分布情况。
我们确定了 1990 年 1 月 1 日至 2019 年 12 月 31 日期间发表的相关人群研究。使用多水平多变量混合效应荟萃回归模型，我们评估了哮喘与研究水平变量的年龄和性别调整关联，包括年份、设置、地区和社会人口指数（SDI）。然后，我们使用随机效应荟萃分析确定了当前喘息和哮喘的风险因素。从“基于风险因素的模型”中，该模型包括当前吸烟和生物量暴露与当前喘息相关，以及农村环境、当前吸烟、生物量暴露和 SDI 与曾经哮喘相关，我们估计了 2019 年各地区和 201 个国家和地区的病例数和发病率。
我们保留了 220 项在 88 个国家进行的基于人群的研究。在 2019 年，通过各种定义，即当前喘息、曾经喘息、当前哮喘和曾经哮喘，5-69 岁人群中哮喘的全球发病率估计分别为 11.5%（95%置信区间[CI]9.1-14.3）、17.9%（95% CI 14.2-22.3）、5.4%（95% CI 3.2-9.0）和 9.8%（95% CI 7.8-12.2）。这分别相当于 754600 万（95% CI 599700-943400）、1181300 万（95% CI 938000-1471000）、357400 万（95% CI 213000-590800）和 645200 万（95% CI 513100-806200）例。5-69 岁人群中当前喘息的总体发病率在非洲区域最高，为 13.2%（95% CI 10.5-16.5），在美洲区域最低，为 10.0%（95% CI 8.0-12.5）。对于曾经哮喘，5-69 岁人群的估计发病率在非洲区域也最高，为 11.3%（95% CI 9.0-14.1），但在东南亚区域最低（8.8，95% CI 7.0-11.0）。
尽管不同环境下病例识别方法的差异使得哮喘的流行病学估计非常困难，但这一分析再次证实，在 2019 年 COVID-19 大流行之前，哮喘是一种常见的全球呼吸道疾病，在许多世界环境中的发病率高于以往报道。
