Amoah Abena S, McLean Estelle, Price Alison J, Amberbir Alemayehu, Crampin Amelia C
Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Malawi Epidemiology and Intervention Research Unit, Chilumba, Malawi.
PLOS Glob Public Health. 2024 Jul 11;4(7):e0002952. doi: 10.1371/journal.pgph.0002952. eCollection 2024.
The growing burden of asthma in low- and middle-income countries has been linked to urbanisation and lifestyle changes. However, this burden has not been well characterised in adults. Therefore, we investigated the prevalence of self-reported diagnosed asthma and associated factors in urban and rural adults in Malawi, Southern Africa. Within a cross-sectional population-based survey to determine the burden and risk factors for non-communicable diseases (NCDs) in the city of Lilongwe and rural Karonga district, we collected information on self-reported previously diagnosed asthma and asthma-related symptoms using an interviewer-led questionnaire. Other data collected included: demographic characteristics, socioeconomic status indicators, NCD comorbidities, environmental exposures, and anthropometric measurements. We used multivariable logistic regression models to explore factors associated with self-reported asthma adjusting for variables associated with the outcome in univariable analysis. Findings were corrected for multiple comparisons using the Bonferroni method. We analysed data from 30,483 adult participants (54.6% urban,45.4% rural and 61.9% female). A prior asthma diagnosis was reported in 5.1% of urban and 4.5% of rural participants. In urban females, being obese (>30 kg/m2) compared to normal weight (18.5-24.9 kg/m2) was associated with greater odds of asthma (OR = 1.59, 95% CI [1.26-2.01], p<0.001), after adjusting for confounders. We observed associations between previously diagnosed heart disease and asthma in female participants which remained significant in rural females after Bonferroni correction (OR = 2.30,95%CI [1.32-4.02], p = 0.003). Among rural males, current smokers had reduced odds of diagnosed asthma (OR = 0.46,95%CI [0.27-0.79], p = 0.004) compared to those who had never smoked. In Malawi the prevalence of self-reported diagnosed asthma was greatest in females and urban dwellers. Notably, our findings indicate relationships between excess body weight as well as comorbidities and diagnosed asthma in females. Future investigations using longitudinally collected data and clinical measurements of asthma are needed to better understand these associations.
低收入和中等收入国家哮喘负担日益加重，这与城市化和生活方式的改变有关。然而，这一负担在成年人中尚未得到充分描述。因此，我们调查了非洲南部马拉维城乡成年人中自我报告的已诊断哮喘的患病率及相关因素。在一项基于人群的横断面调查中，为了确定利隆圭市和卡龙加农村地区非传染性疾病（NCDs）的负担和风险因素，我们使用由访员主导的问卷收集了关于自我报告的既往诊断哮喘和哮喘相关症状的信息。收集的其他数据包括：人口统计学特征、社会经济地位指标、非传染性疾病合并症、环境暴露和人体测量数据。我们使用多变量逻辑回归模型来探索与自我报告哮喘相关的因素，并在单变量分析中对与结果相关的变量进行校正。使用Bonferroni方法对多重比较的结果进行校正。我们分析了30483名成年参与者的数据（54.6%为城市居民，45.4%为农村居民，61.9%为女性）。5.1%的城市参与者和4.5%的农村参与者报告曾被诊断患有哮喘。在城市女性中，与正常体重（18.5 - 24.9kg/m²）相比，肥胖（>30kg/m²）与哮喘的患病几率更高相关（OR = 1.59，95%CI[1.26 - 2.01]，p<0.001），在校正混杂因素后。我们观察到既往诊断的心脏病与女性参与者的哮喘之间存在关联，在Bonferroni校正后，农村女性中这种关联仍然显著（OR = 2.30，95%CI[1.32 - 4.02]，p = 0.003）。在农村男性中，与从未吸烟的人相比，当前吸烟者被诊断为哮喘的几率降低（OR = 0.46，95%CI[0.27 - 0.79]，p = 0.004）。在马拉维，自我报告的已诊断哮喘患病率在女性和城市居民中最高。值得注意的是，我们的研究结果表明女性中超重以及合并症与已诊断哮喘之间存在关联。未来需要使用纵向收集的数据和哮喘的临床测量进行进一步调查，以更好地理解这些关联。
