Departments of Family Medicine and Community Health and of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
Center for Primary Health Care Research, Lund University, Malmö, Sweden.
Thorax. 2023 Jul;78(7):653-660. doi: 10.1136/thorax-2022-218931. Epub 2022 Jul 30.
Preterm birth is associated with pulmonary complications early in life; however, long-term risks of asthma into adulthood are unclear.
To determine asthma risks from childhood into adulthood associated with gestational age at birth in a large population-based cohort.
A national cohort study was conducted of all 4 079 878 singletons born in Sweden during 1973-2013, followed up for asthma identified from primary care, specialty outpatient and inpatient diagnoses in nationwide registries through 2018 (up to 46 years). Cox regression was used to adjust for potential confounders, and cosibling analyses assessed the influence of unmeasured shared familial (genetic and/or environmental) factors.
In 91.9 million person-years of follow-up, 607 760 (14.9%) persons were diagnosed with asthma. Preterm birth was associated with increased risk of asthma at ages <10 years (adjusted HR 1.73; 95% CI 1.70 to 1.75), 10-17 years (1.29; 1.27 to 1.32) and 18-46 years (1.19; 1.17 to 1.22). Across all ages, adjusted HRs further stratified were 3.01 (95% CI 2.88 to 3.15) for extremely preterm (22-27 weeks), 1.76 (1.72 to 1.79) for very or moderately preterm (28-33 weeks), 1.31 (1.29 to 1.32) for late preterm (34-36 weeks) and 1.13 (1.12 to 1.14) for early term (37-38 weeks), compared with full-term (39-41 weeks) birth. These findings were not explained by shared familial factors. Asthma risks were elevated after spontaneous or medically indicated preterm birth and with or without perinatal respiratory complications.
In this large national cohort, preterm and early term birth were associated with increased risks of asthma from childhood into midadulthood. Persons born prematurely need long-term follow-up into adulthood for timely detection and treatment of asthma.
早产与儿童早期的肺部并发症有关；然而，早产与成年后患哮喘的长期风险尚不清楚。
在一个大型基于人群的队列中，确定与出生时胎龄相关的从儿童期到成年期的哮喘风险。
对 1973 年至 2013 年期间在瑞典出生的所有 4079878 名单胎婴儿进行了一项全国性队列研究，通过全国性登记处的初级保健、专科门诊和住院诊断，对哮喘进行了随访，直至 2018 年（最长 46 年）。使用 Cox 回归来调整潜在的混杂因素，同胞分析评估了未测量的共同家族（遗传和/或环境）因素的影响。
在 9190 万个人随访年中，有 607760 人（14.9%）被诊断为哮喘。早产与 10 岁以下（调整后的 HR 1.73；95%CI 1.70 至 1.75）、10-17 岁（1.29；1.27 至 1.32）和 18-46 岁（1.19；1.17 至 1.22）患哮喘的风险增加有关。在所有年龄段，进一步分层的调整后的 HR 为 3.01（95%CI 2.88 至 3.15）为极早产（22-27 周），1.76（1.72 至 1.79）为非常早产或中度早产（28-33 周），1.31（1.29 至 1.32）为晚期早产（34-36 周），1.13（1.12 至 1.14）为早期足月（37-38 周），而足月（39-41 周）出生的风险较低。这些发现不能用共同的家族因素来解释。自发性或医学上有指征的早产以及围产期呼吸并发症的存在或不存在，均与早产和早期足月出生后哮喘风险的增加有关。需要对早产儿进行长期随访至成年，以及时发现和治疗哮喘。
