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Hjern A, Nyberg C, Burström B. Did the choice reform in Stockholm change social disparities in use of outpatient health services for children? Acta Paediatr 2023; 112:1973-1981. [PMID: 37271941 DOI: 10.1111/apa.16864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/20/2023] [Accepted: 06/01/2023] [Indexed: 06/06/2023]
Abstract
AIM The aim of this study was to investigate whether the choice reforms in healthcare in Stockholm county in 2008 and 2013 changed the sociodemographic user patterns of outpatient healthcare services for children. METHODS The study used regional data on healthcare use linked to sociodemographic data from national registers in the total population of children 0-15 years in the Stockholm county. Change in use of healthcare services was analysed in multiple linear regression in a difference in differences approach of socio-economic indicators. RESULTS The choice reform of 2013 increased children's overall use of specialised care by around 30% until 2017 while primary care use decreased by the same degree. The mean number of physician visits in specialised care for children with severe asthma increased from 3.9 to 5.2 per year. Overall, children in families with low maternal education, low disposable income and a non-Western background increased their use of specialised care more than children from families with a more privileged socio-economic situation. CONCLUSION There was no indication that the choice reform in Stockholm county increased the social disparities in use of primary and specialised outpatient care for children, rather the opposite.
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Affiliation(s)
- Anders Hjern
- Centre for Health Equity Studies (CHESS), Karolinska Institutet/Stockholm University, Stockholm, Sweden
- Clinical Epidemiology/Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Bo Burström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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2
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Olsson D, Forsberg B, Bråbäck L, Geels C, Brandt J, Christensen JH, Frohn LM, Oudin A. Early childhood exposure to ambient air pollution is associated with increased risk of paediatric asthma: An administrative cohort study from Stockholm, Sweden. ENVIRONMENT INTERNATIONAL 2021; 155:106667. [PMID: 34077855 DOI: 10.1016/j.envint.2021.106667] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/06/2021] [Accepted: 05/24/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Asthma is a complex, heterogeneous disease and one of the most common chronic diseases among children. Exposure to ambient air pollution in early life and childhood may influence asthma aetiology, but it is uncertain which specific components of air pollution and exposure windows are of importance. The role of socio-economic status (SES) is also unclear. The aims of the present study are, therefore, to investigate how various exposure windows of different pollutants affect risk-induced asthma in early life and to explore the possible effect SES has on that relationship. METHODS The study population was constructed using register data on all singleton births in the greater Stockholm area between 2006 and 2013. Exposure to ambient black carbon (BC), fine particulate matter (PM2.5), primary organic carbon (pOC) secondary organic aerosols (SOA), secondary inorganic aerosols, and oxidative potential at the residential address was modelled as mean values for the entire pregnancy period, the first year of life and the first three years of life. Swedish national registers were used to define the outcome: asthma diagnosis assessed at hospital during the first six years of life. Hazard ratios (HRs) and their 95% confidence intervals (CIs) were modelled with Cox proportional hazards model with age as the underlying time-scale, adjusting for relevant potential confounding variables. RESULTS An increased risk for developing childhood asthma was observed in association with exposure to PM2.5, pOC and SOA during the first three years of life. With an interquartile range increase in exposure, the HRs were 1.06 (95% CI: 1.01-1.10), 1.05 (95% CI: 1.02-1.09) and 1.02 (95% CI: 1.00-1.04), for PM2.5, pOC and SOA, respectively, in the fully adjusted models. Exposure during foetal life or the first year of life was not associated with asthma risk, and the other pollutants were not statistically significantly associated with increased risk. Furthermore, the increase in risk associated with PM2.5 and the components BC, pOC and SOA were stronger in areas with lower SES. CONCLUSION Our results suggest that exposure to air pollution during the first three years of life may increase the risk for asthma in early childhood. The findings further imply a possible increased vulnerability to air pollution-attributed asthma among low SES children.
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Affiliation(s)
- David Olsson
- Department of Public Health and Clinical Medicine, Sustainable Health, Umeå University, Sweden
| | - Bertil Forsberg
- Department of Public Health and Clinical Medicine, Sustainable Health, Umeå University, Sweden
| | - Lennart Bråbäck
- Department of Public Health and Clinical Medicine, Sustainable Health, Umeå University, Sweden
| | - Camilla Geels
- Department of Environmental Science - Atmospheric Modelling, Aarhus University, Denmark
| | - Jørgen Brandt
- Department of Environmental Science - Atmospheric Modelling, Aarhus University, Denmark
| | - Jesper H Christensen
- Department of Environmental Science - Atmospheric Modelling, Aarhus University, Denmark
| | - Lise M Frohn
- Department of Environmental Science - Atmospheric Modelling, Aarhus University, Denmark
| | - Anna Oudin
- Department of Public Health and Clinical Medicine, Sustainable Health, Umeå University, Sweden.
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3
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Biagioni B, Annesi-Maesano I, D'Amato G, Cecchi L. The rising of allergic respiratory diseases in a changing world: from climate change to migration. Expert Rev Respir Med 2020; 14:973-986. [PMID: 32662693 DOI: 10.1080/17476348.2020.1794829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The rising of allergic respiratory diseases (ARDs) suggests a decisive role of environmental factors, that have dramatically changed in the last decades. AREAS COVERED This review addresses various aspects of the external exposome acting on the development, progression, clinical presentation and severity of ARDs. Climate change, air pollution and biodiversity loss act directly and through their complex interactions on atopic risk: reacent foundings on these aspects are discussed herein. The review also focuses on migration studies, underling the possible role of migrant status as an experimental model to study environment effects on atopy onset and progression. EXPERT OPINION Future perspective on this topic include prevention and mitigation strategies in regard to pollution and climate change, improvement of environmental monitoring methods, implementation of public health policies, further advances in 'omics' research and knowledge, prospective and immunological research on migrant populations and new policies to face human mobility.
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Affiliation(s)
- Benedetta Biagioni
- Allergy Unit, Department of Pediatric Medicine, Anna Meyer Childrens University Hospital , Florence, Italy
| | - Isabella Annesi-Maesano
- Epidemiology of Allergic and Respiratory Diseases Department, Institute Pierre Louis of Epidemiology and Public Health, INSERM and Sorbonne Université , Paris, France
| | - Gennaro D'Amato
- Division of Respiratory and Allergic Diseases, Department of Chest Diseases, High Speciality A. Cardarelli Hospital , Napoli, Italy.,Medical School of Specialization in Respiratory Diseases, University on Naples Federico II , Naples, Italy
| | - Lorenzo Cecchi
- SOS Allergy and Clinical Immunology - Prato, USL Toscana Centro , Florence, Italy.,Centre of Bioclimatology, University of Florence , Florence, Italy
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4
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Lloyd CM, Saglani S. Opening the Window of Immune Opportunity: Treating Childhood Asthma. Trends Immunol 2019; 40:786-798. [PMID: 31420279 DOI: 10.1016/j.it.2019.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/18/2019] [Accepted: 07/18/2019] [Indexed: 12/13/2022]
Abstract
Asthma is an increasingly common childhood disease and although most patients can control their symptoms with medication, a proportion experience life-threatening symptoms. The advent of novel biologic therapies represents a giant leap forward for asthma treatment, but efficacy is rarely tested in children. Recent mechanistic work in mice suggests that early life is a key period for immune development and, therefore, allergen sensitization. Although children with severe asthma experience significant comorbidities and are at increased risk for serious diseases such as chronic obstructive pulmonary disease as adults, no specific investigation into tailored treatment for young children with severe asthma exists. Here, we propose how new information regarding early life immunity could be used to inform modified treatments for children.
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Affiliation(s)
- Clare M Lloyd
- Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College, London, UK.
| | - Sejal Saglani
- Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College, London, UK.
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5
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Research Needs on Respiratory Health in Migrant and Refugee Populations. An Official American Thoracic Society and European Respiratory Society Workshop Report. Ann Am Thorac Soc 2018; 15:1247-1255. [DOI: 10.1513/annalsats.201807-478st] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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6
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Suaini NHA, Koplin JJ, Peters RL, Sasaki M, Ellis JA, Martino DJ, Lowe AJ, Tang MLK, Ponsonby AL, Gurrin LC, Dharmage SC, Allen KJ. Children with East Asian-Born Parents Have an Increased Risk of Allergy but May Not Have More Asthma in Early Childhood. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:539-547.e3. [PMID: 30149095 DOI: 10.1016/j.jaip.2018.07.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 07/17/2018] [Accepted: 07/18/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND We previously reported that infants with Asian-born parents are 3 times more likely to have IgE-mediated food allergy than those with Australian-born parents. It is unknown whether this translates to the increased risk of other allergic diseases later in childhood and whether ancestry interacts with other risk factors for allergic disease development. OBJECTIVE To compare prevalence and risk factors for allergic rhinitis, asthma, and aeroallergen sensitization at age 6 between children with East Asian-born and Caucasian-born parents. METHODS A total of 5276 1-year-old infants were recruited into a population-based longitudinal study of allergy. A total of 4455 children participated in age 6 follow-up (84.4%), including 3015 with Caucasian-born parents and 415 with East Asian-born parents. Children underwent skin prick tests to aeroallergens and questionnaires captured data on asthma, eczema, and allergic rhinitis. RESULTS Compared with children with Caucasian-born parents, children of East Asian-born parents had more allergic rhinitis (19.9% [95% confidence interval (CI) 14.9-26] vs 9.3% [95% CI 8-10.8], P < .001) and aeroallergen sensitization (64.3% [95% CI 57.5-70.5] vs 34.4% [95% CI 32.2-36.7], P < .001) at age 6. Asthma was similar in both groups (9.1% [95% CI 6.2-13.2] vs 11.7% [95% CI 10.4-13.1]), P = .21. Children with IgE-mediated food allergy and eczema in infancy were 3 times more likely to have asthma and 2 times more likely to have allergic rhinitis at age 6, irrespective of ancestry. CONCLUSIONS Children of East Asian ancestry born in Australia have a higher burden of most allergic diseases in the first 6 years of life, whereas asthma may follow a different pattern. IgE-mediated food allergy and eczema at age 1 increase the risk of asthma and allergic rhinitis irrespective of ancestry.
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Affiliation(s)
- Noor H A Suaini
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Jennifer J Koplin
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia; The School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Rachel L Peters
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Mari Sasaki
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Justine A Ellis
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Centre for Social and Early Emotional Development, Faculty of Health, Deakin University, Burwood, Victoria, Australia; Genes, Environment & Complex Disease, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - David J Martino
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Adrian J Lowe
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia; The School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Mimi L K Tang
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Allergy and Clinical Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Anne-Louise Ponsonby
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia; The School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Lyle C Gurrin
- The School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Shyamali C Dharmage
- The School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Katrina J Allen
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Allergy and Clinical Immunology, Royal Children's Hospital, Parkville, Victoria, Australia; Institute of Inflammation and Repair, University of Manchester, Manchester, United Kingdom.
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7
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Turner JD. Childhood adversity from conception onwards: are our tools unnecessarily hindering us? J Behav Med 2018; 41:568-570. [PMID: 29802534 DOI: 10.1007/s10865-018-9939-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 05/16/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Jonathan D Turner
- Department of Infection and Immunity, Luxembourg Institute of Health, 29 rue Henri Koch, 4354, Esch-sur-Alzette, Luxembourg.
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8
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Richter JC, Jakobsson K, Taj T, Oudin A. High burden of atopy in immigrant families in substandard apartments in Sweden - on the contribution of bad housing to poor health in vulnerable populations. World Allergy Organ J 2018; 11:9. [PMID: 29796150 PMCID: PMC5952630 DOI: 10.1186/s40413-018-0188-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 04/24/2018] [Indexed: 12/29/2022] Open
Abstract
Background Atopic disorders are a global concern. Studies in migrant populations can illuminate the interplay of genetic and environmental factors. Exposures related to bad housing (indoor dampness, mould growth, crowding etc.) are likely to play a role in how socioeconomic inequalities can turn into health disparities for disadvantaged populations. The sizable immigrant population living in very poor-quality housing in Malmö, Sweden, became the focus of a cross-sectional study. Objective To describe atopic disorders and sensitizations in a population living in substandard housing in Malmö, Sweden, with an emphasis on their relation to harmful exposures from the built environment. Methods Families were recruited via identification of any children with symptomatic airway afflictions from health care records, and also asymptomatic children from school lists. Interviewer-led health questionnaire data and data from self-reports about living conditions were obtained together with data from home inspections carried out by health communicators. Families underwent skin prick tests (SPT) against common aeroallergens. Results As could be expected from background demographic information, it turned out that we effectively studied an immigrant population inhabiting very precarious housing outside the center of Malmö. A total of 359 children from 130 families (total 650 participants) were included. Overall the prevalence of potentially harmful environmental exposures was high (signs of moisture or mould in more than 50% of apartments, indoor smoking in 37% of households). Atopic disorders were common among both adults and children. SPTs showed a spectrum of sensitizations consistent with unselected populations in Sweden. Paternal sensitization in the SPT was associated with higher risk of sensitization for offspring than maternal sensitization. Few statistically significant associations of atopic sensitization with studied environmental exposures were detected (for example objective signs of dampness /mould in bathrooms). There were marked discrepancies between asthma diagnoses obtained from the health records and parental reports of such diagnoses and treatment for their children. Conclusions The atopic burden in this selected immigrant population was high, and results point to unmet medical needs. Health care systems caring for such populations need to be aware of their specific health needs; comprehensive asthma and allergy care should include consideration of harmful environmental exposures, adhering to the precautionary principle.
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Affiliation(s)
- Jens Christian Richter
- 1Division of Occupational and Environmental Medicine, Medical Faculty, Lund University, 22185 Lund, Sweden.,2Department of Respiratory Medicine and Allergology, Lund University Hospital, Region Skåne, Lund, Sweden
| | - Kristina Jakobsson
- 1Division of Occupational and Environmental Medicine, Medical Faculty, Lund University, 22185 Lund, Sweden.,3Department of Occupational and Environmental Medicine, Göteborgs Universitet, Gothenburg, Sweden
| | - Tahir Taj
- 1Division of Occupational and Environmental Medicine, Medical Faculty, Lund University, 22185 Lund, Sweden
| | - Anna Oudin
- 1Division of Occupational and Environmental Medicine, Medical Faculty, Lund University, 22185 Lund, Sweden
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9
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Tchidjou HK, Vescio MF, Serafinelli J, Giampaolo R, Jenkner A, Tadonkeng MC, Avellis L, Fiocchi A, Pezzotti P, Rezza G, Rossi P. Susceptibility to allergy in adoptive children: a cross-sectional study at "Bambino Gesù Children's Hospital". Ital J Pediatr 2018; 44:3. [PMID: 29301554 PMCID: PMC5755410 DOI: 10.1186/s13052-017-0440-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 12/14/2017] [Indexed: 11/13/2022] Open
Abstract
Background Prevalence of allergy has steeply increased during the past few decades, particularly in high-income countries. The development of atopy could present different characteristics in internationally adopted children with regard to incidence, specific patterns of allergies and timing of occurrence. We aimed to investigate the occurrence of allergic diseases among adopted children in Italy. Methods We collected demographic information, preadoption immunization data, infectious diseases screening results, immunological status, and performed hematological and biochemical tests according to a standardized protocol in 108 adopted children. Results At initial visit (mean age was 5.7 ± 3.2 years), 48 children displayed elevated total serum IgE levels with a prevalence of 56.5% (95%CI: 0.45; 0.67). The prevalences of children screened positive for one or more food allergens and inhalants were 30.1% (95%CI: 19.9%; 42.0%) and 34.3% (95%CI: 23.3%; 46.6%) respectively, only 9 children exhibited abnormal absolute eosinophil counts, 23 (21.3%) had a parasitic infection and 60 (55.6%) had received at least one dose of vaccine. Conclusions Children without medical records or with a past medical history suggestive of atopy should perform a thorough allergy evaluation at the time of adoption. Our study offers also a glimpse at the vaccination status and immune-allergic profiles of recent migrant children in Italy.
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Affiliation(s)
- Hyppolite K Tchidjou
- Division of Immunology and Infectious Diseases, University-Hospital Pediatric Department (DPUO), Bambino Gesù Children Hospital, Piazza Sant'Onofrio 4, 00165, Rome, Italy.
| | - Maria Fenicia Vescio
- Epidemiology Unit, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Jessica Serafinelli
- Division of Immunology and Infectious Diseases, University-Hospital Pediatric Department (DPUO), Bambino Gesù Children Hospital, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Rosaria Giampaolo
- Department of Pediatric Medicine, University Department of Pediatrics (DPUO), Children's Hospital Bambino Gesù, Rome, Italy
| | - Alessandro Jenkner
- Division of Immunology and Infectious Diseases, University-Hospital Pediatric Department (DPUO), Bambino Gesù Children Hospital, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | | | - Luca Avellis
- Epidemiology Unit, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Alessandro Fiocchi
- Division of Allergy, University Department of Pediatrics (DPUO), Children's Hospital Bambino Gesù, Rome, Italy
| | - Patrizio Pezzotti
- Epidemiology Unit, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Giovanni Rezza
- Epidemiology Unit, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Paolo Rossi
- Division of Immunology and Infectious Diseases, University-Hospital Pediatric Department (DPUO), Bambino Gesù Children Hospital, Piazza Sant'Onofrio 4, 00165, Rome, Italy
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10
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Oudin A, Bråbäck L, Oudin Åström D, Forsberg B. Air Pollution and Dispensed Medications for Asthma, and Possible Effect Modifiers Related to Mental Health and Socio-Economy: A Longitudinal Cohort Study of Swedish Children and Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14111392. [PMID: 29144419 PMCID: PMC5708031 DOI: 10.3390/ijerph14111392] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/09/2017] [Accepted: 11/11/2017] [Indexed: 12/30/2022]
Abstract
It has been suggested that children that are exposed to a stressful environment at home have an increased susceptibility for air pollution-related asthma. The aim here was to investigate the association between air pollution exposure and asthma, and effect modification by mental health and by socio-economic status (as markers of a stressful environment). All individuals under 18 years of age in four Swedish counties during 2007 to 2010 (1.2 million people) were included. The outcome was defined as dispensing at least two asthma medications during follow up. We linked data on NO2 from an empirical land use regression to data from national registers on outcome and potential confounders. Data was analyzed with logistic regression. There was an odds ratio (OR) of 1.02 (95% Confidence Interval (CI: 1.01–1.03) for asthma associated with a 10 µg·m−3 increase in NO2. The association only seemed to be present in areas where NO2 was higher than 15 µg·m−3 with an OR of 1.09 (95% CI: 1.07–1.12), and the association seemed stronger in children with parents with a high education, OR = 1.05 (95% CI: 1.02–1.09) and OR = 1.04 (95% CI: 1.01–1.07) in children to mothers and father with a high education, respectively. The association did not seem to depend on medication history of psychiatric disorders. There was weak evidence for the association between air pollution and asthma to be stronger in neighborhoods with higher education levels. In conclusion, air pollution was associated with dispensed asthma medications, especially in areas with comparatively higher levels of air pollution, and in children to parents with high education. We did not observe support for our hypothesis that stressors linked to socio-economy or mental health problems would increase susceptibility to the effects of air pollution on the development of asthma.
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Affiliation(s)
- Anna Oudin
- Occupational and Environmental Medicine, Umeå University, 90187 Umeå, Sweden.
| | - Lennart Bråbäck
- Occupational and Environmental Medicine, Umeå University, 90187 Umeå, Sweden.
| | - Daniel Oudin Åström
- Occupational and Environmental Medicine, Umeå University, 90187 Umeå, Sweden.
| | - Bertil Forsberg
- Occupational and Environmental Medicine, Umeå University, 90187 Umeå, Sweden.
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11
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Lodge CJ, Bråbäck L, Lowe AJ, Dharmage SC, Olsson D, Forsberg B. Grandmaternal smoking increases asthma risk in grandchildren: A nationwide Swedish cohort. Clin Exp Allergy 2017; 48:167-174. [PMID: 28925522 DOI: 10.1111/cea.13031] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 07/31/2017] [Accepted: 08/28/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is growing interest in exposures prior to conception as possible risk factors for offspring asthma. Although partially supported by evidence from limited human studies, current evidence is inconsistent and based on recall of exposure status. OBJECTIVE We aimed to investigate grandmaternal smoking during pregnancy and the risk of asthma in grandchildren using prospectively collected population-based data. METHODS Information on grandmaternal and maternal smoking during pregnancy and grandchild use of asthma medications was collected from national Swedish registries. Associations between grandmaternal smoking during pregnancy (10-12 weeks) and asthma medication use in grandchildren were investigated using generalized estimating equations. Ages at which asthma medications were prescribed classified childhood asthma into never, early transient (0-3 years), late onset (3-6 years) and early persistent (0-3 and 3-6 years) phenotypes. RESULTS From 1982 to 1986, 44 583 grandmothers gave birth to 46 197 mothers, who gave birth to 66 271 grandchildren (born 1996-2010). Children aged 1-6 years had an increased asthma risk if their grandmothers had smoked during pregnancy, with a higher risk for more exposure (10+ cigs/d; adjusted OR 1.23; 1.17, 1.30). Maternal smoking did not modify this relationship. CONCLUSIONS & CLINICAL RELEVANCE Children had an increased risk of asthma in the first 6 years of life if their grandmothers smoked during early pregnancy, independent of maternal smoking. Importantly, this exhibited a dose-response relationship and was associated with a persistent childhood asthma phenotype. These findings support possible epigenetic transmission of risk from environmental exposures in previous generations.
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Affiliation(s)
- C J Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Vic., Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Melbourne, Vic., Australia.,Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - L Bråbäck
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - A J Lowe
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Vic., Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Melbourne, Vic., Australia.,Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - S C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Vic., Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Melbourne, Vic., Australia
| | - D Olsson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - B Forsberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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12
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Leung JYY, Leung GM, Schooling CM. Migrant status and childhood hospitalizations for asthma and other wheezing disorders. Clin Exp Allergy 2017; 47:675-683. [PMID: 28160339 DOI: 10.1111/cea.12896] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/29/2016] [Accepted: 01/03/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND In developed Western settings, asthma is more prevalent among second-generation compared to first-generation migrants. However, these studies are difficult to interpret as they include migrants of various ethnicities and countries of origin. OBJECTIVE We assessed the association of parental migrant status with wheezing disorders among children born in Hong Kong, a developed non-Western setting, where many children have migrant parents from mainland China of the same ethnicity. METHODS We used Cox regression to examine the adjusted associations of parental migrant status with time to first public hospital admission for asthma, bronchitis and bronchiolitis (International Classification of Diseases, Ninth Version Clinical Modification 466, 490 and 493) from 9 days to 12 years in a population-representative birth cohort of 8327 Chinese children in Hong Kong. RESULTS Having both parents as migrants was associated with higher risk of hospitalization for asthma and other wheezing disorders, compared to both parents being Hong Kong born (hazard ratio 1.30, 95% confidence interval 1.05-1.60 from 9 days to 6 years), adjusted for type of hospital at birth, parental history of allergies, mother's age at birth, father's age at birth and highest parental education. CONCLUSIONS AND CLINICAL RELEVANCE In the unique, non-Western context of Hong Kong, second-generation migrants had higher risk of hospitalization for childhood wheezing disorders compared to the native population, particularly before 6 years of age. Further study is required to clarify the underlying mechanisms involved.
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Affiliation(s)
- J Y Y Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - G M Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - C M Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,School of Public Health and Health Policy, City University of New York, New York, NY, USA
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Fadnes LT, Diaz E. Primary healthcare usage and use of medications among immigrant children according to age of arrival to Norway: a population-based study. BMJ Open 2017; 7:e014641. [PMID: 28148537 PMCID: PMC5294001 DOI: 10.1136/bmjopen-2016-014641] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Morbidity, use of healthcare and medication use have been reported to vary across groups of migrants and according to the different phases of migration, but little is known about children with immigrant background. In this study, we investigate whether the immigrant children's age of arrival predicts differences in usage of primary healthcare (PHC) and in use of prescribed medication. METHODS This nationwide, population-based study used information for children under 18 years of age in 2008 from three linked registers in Norway. Use of medication was assessed with logistic regression analyses presented with ORs with 95% CIs. RESULTS Of 1 168 365 children, 119 251 had immigrant background. The mean number of PHC visits among children aged 10-18 years, was 1.19 for non-immigrants, 1.17 among second generation immigrants, 1.12, 1.05 and 0.83 among first immigrant children who were <5, 5-9 and ≥10 years at arrival in Norway, respectively. Patterns were similar for younger immigrants, and were confirmed with regression models adjusting for age and sex. First generation immigrant children used less of nearly all groups of prescribed medication compared to non-immigrants when adjusting for age and sex (overall OR 0.48 (0.47 to 0.49)), and medication was also generally less used among second generation immigrant children (overall OR 0.92 (0.91 to 0.94)). CONCLUSIONS Age of arrival predicted PHC usage among children among first-generation children. First-generation immigrant children, particularly those arriving later in adolescence, used PHC less than age corresponding non-immigrant children. Immigrant children used less prescribed medication compared to non-immigrants after adjustment for age and sex.
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Affiliation(s)
- Lars T Fadnes
- Department of Clinical Dentistry,
University of Bergen, Bergen,
Norway
- Department of Global Public Health and Primary Care,
University of Bergen, Bergen,
Norway
| | - Esperanza Diaz
- Department of Global Public Health and Primary Care,
University of Bergen, Bergen,
Norway
- Norwegian Centre for Minority Health Research,
Norway
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Kozyrskyj AL, Letourneau NL, Kang LJ, Salmani M. Associations between postpartum depressive symptoms and childhood asthma diminish with child age. Clin Exp Allergy 2016; 47:324-330. [PMID: 27770463 DOI: 10.1111/cea.12837] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 08/16/2016] [Accepted: 09/15/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Affecting 19% of women, postpartum depression is a major concern to the immediate health of mothers and infants. In the long-term, it has been linked to the development of early-onset asthma at school entry, but only if the depression persists beyond the postnatal period. No studies have tested whether associations with postpartum depressive symptoms and early-onset asthma phenotypes persist into later school age. OBJECTIVE To determine associations between maternal postpartum depressive symptoms and childhood asthma between the ages of 5-10 by using a nested longitudinal design. METHODS Data were drawn from the 1994-2004 administrations of the Canadian National Longitudinal Survey of Children and Youth, which tracks the health of a nationally representative sample of children in Canada. Child asthma was diagnosed by a health professional, and maternal depressive symptoms were assessed by the Centre for Epidemiological Studies Depression scale. Analyses were conducted by using a multilevel modelling approach, in which longitudinal assessments of asthma in 1696 children were nested within the exposure of postpartum depression. RESULTS Postpartum depressive symptoms had a 1.5-fold significant association with childhood asthma between the ages 6-8. This was independent of male sex, maternal asthma, non-immigrant status, low household socioeconomic status, being firstborn, low birthweight, low family functioning and urban-rural residence, of which the first 4 covariates elevated the risk of asthma. Statistical significance was lost at age 8 when maternal prenatal smoking replaced urban-rural residence as a covariate. At ages 9-10, an association was no longer evident. CONCLUSIONS AND CLINICAL RELEVANCE Women affected by postpartum depressive symptoms are concerned about long-term health effects of their illness on their infants. Although postpartum depressive symptoms were associated with school-age asthma at ages 6 and 7, this association diminished later. Both home and school life stress should be considered in future studies on asthma development later in childhood.
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Affiliation(s)
- A L Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,School of Public Health, University of Alberta, Edmonton, AB, Canada.,Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB, Canada
| | - N L Letourneau
- Faculty of Nursing & Cumming School of Medicine (Pediatrics & Psychiatry), University of Calgary, Calgary, AB, Canada
| | - L J Kang
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - M Salmani
- Department of Mathematics & Statistics, University of New Brunswick, Fredericton, NB, Canada
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Lefeuvre D, Delmas MC, Marguet C, Chauvin P, Vandentorren S. Asthma-Like Symptoms in Homeless Children in the Greater Paris Area in 2013: Prevalence, Associated Factors and Utilization of Healthcare Services in the ENFAMS Survey. PLoS One 2016; 11:e0153872. [PMID: 27082960 PMCID: PMC4833414 DOI: 10.1371/journal.pone.0153872] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 04/05/2016] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Asthma remains poorly studied in homeless children. We sought to estimate the prevalence of asthma-like symptoms (ALS) and to identify the factors associated with ALS and healthcare service utilisation. MATERIALS AND METHODS A cross-sectional survey of a random sample of sheltered homeless families was conducted by interviewing 801 parents of children (0-12 years) in 17 languages. ALS were defined as wheezing or night cough without fever during the previous year. Poisson regression models with robust error variance were used to compute prevalence ratios (PR) for factors associated with ALS and healthcare service utilisation for ALS. RESULTS The prevalence of ALS among the children was 19.9%. Poor housing sanitation was significantly associated with ALS, as being born in the European Union. Most of the children with ALS had used healthcare services (85.4%). The main barriers to accessing such services were having lived in France for less than 49 months, having difficulties in French and living in poor housing conditions. CONCLUSION ALS prevalence seemed lower than in the general child population, possibly because of the children's origins. Environmental factors associated with ALS point to the need to improve the indoor environment of family shelters. The relatively high rate of healthcare service utilisation should not overshadow existing barriers.
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Affiliation(s)
- Delphine Lefeuvre
- INSERM, Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of social epidemiology, Paris, France
| | | | | | - Pierre Chauvin
- INSERM, Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of social epidemiology, Paris, France
| | - Stéphanie Vandentorren
- INSERM, Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of social epidemiology, Paris, France
- French Institute for Public Health Surveillance, Saint-Maurice, France
- Observatoire du Samusocial de Paris, Paris, France
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Barr RG, Avilés-Santa L, Davis SM, Aldrich TK, Gonzalez F, Henderson AG, Kaplan RC, LaVange L, Liu K, Loredo JS, Mendes ES, Ni A, Ries A, Salathe M, Smith LJ. Pulmonary Disease and Age at Immigration among Hispanics. Results from the Hispanic Community Health Study/Study of Latinos. Am J Respir Crit Care Med 2016; 193:386-95. [PMID: 26451874 PMCID: PMC4803083 DOI: 10.1164/rccm.201506-1211oc] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 10/09/2015] [Indexed: 12/19/2022] Open
Abstract
RATIONALE Asthma has been reported to be more prevalent among Hispanics of Puerto Rican heritage than among other Hispanics and among Hispanics born in the United States or who immigrated as children than among those who came as adults; however, direct comparisons across Hispanic groups are lacking. OBJECTIVES To test whether asthma is more prevalent among Hispanics of Puerto Rican heritage than among other Hispanic groups, whether asthma is associated with age of immigration, and whether chronic obstructive pulmonary disease varies by heritage in a large, population-based cohort of Hispanics in the United States. METHODS The Hispanic Community Health Study/Study of Latinos researchers recruited a population-based probability sample of 16,415 Hispanics/Latinos, 18-74 years of age, in New York City, Chicago, Miami, and San Diego. Participants self-reported Puerto Rican, Cuban, Dominican, Mexican, Central American, or South American heritage; birthplace; and, if relevant, age at immigration. A respiratory questionnaire and standardized spirometry were performed with post-bronchodilator measures for those with airflow limitation. MEASUREMENTS AND MAIN RESULTS The prevalence of physician-diagnosed asthma among Puerto Ricans (36.5%; 95% confidence interval, 33.6-39.5%) was higher than among other Hispanics (odds ratio, 3.9; 95% confidence interval, 3.3-4.6). Hispanics who were born in the mainland United States or had immigrated as children had a higher asthma prevalence than those who had immigrated as adults (19.6, 19.4, and 14.1%, respectively; P < 0.001). Current asthma, bronchodilator responsiveness, and wheeze followed similar patterns. Chronic obstructive pulmonary disease prevalence was higher among Puerto Ricans (14.1%) and Cubans (9.8%) than among other Hispanics (<6.0%), but it did not vary across Hispanic heritages after adjustment for smoking and prior asthma (P = 0.22), by country of birth, or by age at immigration. CONCLUSIONS Asthma was more prevalent among Puerto Ricans, other Hispanics born in the United States, and those who had immigrated as children than among other Hispanics. In contrast, the higher prevalence of chronic obstructive pulmonary disease among Puerto Ricans and Cubans was largely reflective of differential smoking patterns and asthma.
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Affiliation(s)
- R. Graham Barr
- Department of Medicine and
- Department of Epidemiology, Columbia University Medical Center, New York, New York
| | - Larissa Avilés-Santa
- Division of Cardiovascular Sciences, NHLBI, National Institutes of Health, Bethesda, Maryland
| | | | | | | | - Ashley G. Henderson
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Robert C. Kaplan
- Department of Epidemiology, Albert Einstein College of Medicine, Bronx, New York
| | | | - Kiang Liu
- Department of Preventative Medicine and
| | - Jose S. Loredo
- Department of Medicine, University of California, San Diego, La Jolla, California; and
| | | | - Ai Ni
- Department of Biostatistics and
| | - Andrew Ries
- Department of Medicine, University of California, San Diego, La Jolla, California; and
| | | | - Lewis J. Smith
- Department of Medicine, Northwestern University, Chicago, Illinois
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Respiratory allergy in immigrants to a highly industrialised area in Italy according to area of origin and time period. Allergol Immunopathol (Madr) 2015; 43:461-8. [PMID: 25456530 DOI: 10.1016/j.aller.2014.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 07/10/2014] [Accepted: 07/31/2014] [Indexed: 01/23/2023]
Abstract
BACKGROUND Migrants from developing to Western countries tend to become more sensitised to host than to origin country allergens, although substantial changes in migration patterns have occurred in recent decades. METHODS We investigated adult immigrants with respiratory allergy, first tested for allergic sensitisation between 1985 and 2012 in a highly industrialised area in Italy. A comparison was made of the sensitisation pattern between immigrants and a random sample of native-born subjects affected by a respiratory allergy, and among immigrants according to macro-region of origin and time period. RESULTS Between 1985 and 2012, 480 immigrants with respiratory allergy had a first positive allergy test. Immigrants were sensitised mainly to grass (67.1%), house dust mites (HDM) (38.5%) and birch (27.5%), with a pattern of sensitisation very similar to that observed in Italians (native-born). An increase in the proportion of subjects with asthma and of subjects with polysensitisation was observed from the first (1985-2002) to the middle (2003-2007) and the most recent period (2008-2012). In recent years, the proportion of subjects with polysensitisation in immigrants is higher than in Italians (native-born) (53.3% vs. 40.1%). Among immigrants, the risk of sensitisation to grass was higher in those from Sub-Saharan Africa (odds ratio, OR=2.76) and Latin America (OR=2.49), whereas risk of sensitisation to HDM was higher among immigrants from South Asia (OR=2.71), compared to immigrants from Eastern Europe. CONCLUSIONS Immigrants develop multiple sensitisations more frequently than native-born people, and are especially sensitised to local allergens; the country of origin seems to play a role.
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Influences of large sets of environmental exposures on immune responses in healthy adult men. Sci Rep 2015; 5:13367. [PMID: 26306804 PMCID: PMC4549790 DOI: 10.1038/srep13367] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 07/13/2015] [Indexed: 11/19/2022] Open
Abstract
Environmental factors have long been known to influence immune responses. In particular, clinical studies about the association between migration and increased risk of atopy/asthma have provided important information on the role of migration associated large sets of environmental exposures in the development of allergic diseases. However, investigations about environmental effects on immune responses are mostly limited in candidate environmental exposures, such as air pollution. The influences of large sets of environmental exposures on immune responses are still largely unknown. A simulated 520-d Mars mission provided an opportunity to investigate this topic. Six healthy males lived in a closed habitat simulating a spacecraft for 520 days. When they exited their “spacecraft” after the mission, the scenario was similar to that of migration, involving exposure to a new set of environmental pollutants and allergens. We measured multiple immune parameters with blood samples at chosen time points after the mission. At the early adaptation stage, highly enhanced cytokine responses were observed upon ex vivo antigen stimulations. For cell population frequencies, we found the subjects displayed increased neutrophils. These results may presumably represent the immune changes occurred in healthy humans when migrating, indicating that large sets of environmental exposures may trigger aberrant immune activity.
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Abstract
BACKGROUND AND OBJECTIVE The hygiene hypothesis stipulates that microbial exposure during early life induces immunologic tolerance via immune stimulation, and hence reduces the risk of allergy development. Several common lifestyle factors and household practices, such as dishwashing methods, may increase microbial exposure. The aim of this study was to investigate if such lifestyle factors are associated with allergy prevalence. METHODS Questionnaire-based study of 1029 children aged 7 to 8 years from Kiruna, in the north of Sweden, and Mölndal, in the Gothenburg area on the southwest coast of Sweden. Questions on asthma, eczema, and rhinoconjunctivitis were taken from the International Study of Asthma and Allergies in Childhood questionnaire. RESULTS Hand dishwashing was associated with a reduced risk of allergic disease development (multivariate analysis, odds ratio 0.57; 95% confidence interval: 0.37-0.85). The risk was further reduced in a dose-response pattern if the children were also served fermented food and if the family bought food directly from farms. CONCLUSIONS In families who use hand dishwashing, allergic diseases in children are less common than in children from families who use machine dishwashing. We speculate that a less-efficient dishwashing method may induce tolerance via increased microbial exposure.
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Affiliation(s)
- Bill Hesselmar
- Paediatric Allergology, Queen Silvia Children's Hospital, Gothenburg, Sweden; Västra Götaland Healthcare Department, Follow-up and Analysis Unit, Gothenburg, Sweden; Department of Paediatrics, University of Gothenburg, Gothenburg, Sweden; and
| | | | - Göran Wennergren
- Paediatric Allergology, Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Paediatrics, University of Gothenburg, Gothenburg, Sweden; and
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20
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Garcia-Marcos L, Robertson CF, Ross Anderson H, Ellwood P, Williams HC, Wong GW. Does migration affect asthma, rhinoconjunctivitis and eczema prevalence? Global findings from the international study of asthma and allergies in childhood. Int J Epidemiol 2014; 43:1846-54. [PMID: 25056339 DOI: 10.1093/ije/dyu145] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Immigrants to Westernized countries adopt the prevalence of allergic diseases of native populations, yet no data are available on immigrants to low-income or low-disease prevalence countries. We investigated these questions using data from the International Study of Asthma and Allergies in Childhood. METHODS Standardized questionnaires were completed by 13-14-year-old adolescents and by the parent/guardians of 6-7-year-old children. Questions on the symptom prevalence of asthma, rhinoconjunctivitis and eczema, and a wide range of factors postulated to be associated with these conditions, including birth in or not in the country and age at immigration, were asked. Odds ratios for risk of the three diseases according to immigration status were calculated using generalized linear mixed models. These were adjusted for: world region; language and gross national income; and individual risk factors including gender, maternal education, antibiotic and paracetamol use, maternal smoking, and diet. Effect modification by gross national income and by prevalence was examined. RESULTS There were 326 691 adolescents from 48 countries and 208 523 children from 31 countries. Immigration was associated with a lower prevalence of asthma, rhinoconjunctivitis and eczema in both age groups than among those born in the country studied, and this association was mainly confined to high-prevalence/affluent countries. This reduced risk was greater in those who had lived fewer years in the host country. CONCLUSIONS Recent migration to high prevalence/affluent countries is associated with a lower prevalence of allergic diseases. The protective pre-migration environment quickly decreases with increasing time in the host country.
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Affiliation(s)
- Luis Garcia-Marcos
- Respiratory Medicine and Allergy Units, Virgen de la Arrixaca University Children's Hospital, University of Murcia, Murcia, Spain, Murdoch Children's Research Institute, Melbourne, Australia, MRC Centre for Environment and Health, St George's, University of London, London, UK, Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand, Centre of Evidence-Based Dermatology, University of Nottingham, Nottingham, UK and Department of Paediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China. The ISAAC Phase Three Study group are listed under Supplementary data at IJE online
| | - Colin F Robertson
- Respiratory Medicine and Allergy Units, Virgen de la Arrixaca University Children's Hospital, University of Murcia, Murcia, Spain, Murdoch Children's Research Institute, Melbourne, Australia, MRC Centre for Environment and Health, St George's, University of London, London, UK, Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand, Centre of Evidence-Based Dermatology, University of Nottingham, Nottingham, UK and Department of Paediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China. The ISAAC Phase Three Study group are listed under Supplementary data at IJE online
| | - H Ross Anderson
- Respiratory Medicine and Allergy Units, Virgen de la Arrixaca University Children's Hospital, University of Murcia, Murcia, Spain, Murdoch Children's Research Institute, Melbourne, Australia, MRC Centre for Environment and Health, St George's, University of London, London, UK, Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand, Centre of Evidence-Based Dermatology, University of Nottingham, Nottingham, UK and Department of Paediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China. The ISAAC Phase Three Study group are listed under Supplementary data at IJE online
| | - Philippa Ellwood
- Respiratory Medicine and Allergy Units, Virgen de la Arrixaca University Children's Hospital, University of Murcia, Murcia, Spain, Murdoch Children's Research Institute, Melbourne, Australia, MRC Centre for Environment and Health, St George's, University of London, London, UK, Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand, Centre of Evidence-Based Dermatology, University of Nottingham, Nottingham, UK and Department of Paediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China. The ISAAC Phase Three Study group are listed under Supplementary data at IJE online
| | - Hywel C Williams
- Respiratory Medicine and Allergy Units, Virgen de la Arrixaca University Children's Hospital, University of Murcia, Murcia, Spain, Murdoch Children's Research Institute, Melbourne, Australia, MRC Centre for Environment and Health, St George's, University of London, London, UK, Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand, Centre of Evidence-Based Dermatology, University of Nottingham, Nottingham, UK and Department of Paediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China. The ISAAC Phase Three Study group are listed under Supplementary data at IJE online
| | - Gary Wk Wong
- Respiratory Medicine and Allergy Units, Virgen de la Arrixaca University Children's Hospital, University of Murcia, Murcia, Spain, Murdoch Children's Research Institute, Melbourne, Australia, MRC Centre for Environment and Health, St George's, University of London, London, UK, Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand, Centre of Evidence-Based Dermatology, University of Nottingham, Nottingham, UK and Department of Paediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China. The ISAAC Phase Three Study group are listed under Supplementary data at IJE online
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Lindgren A, Stroh E, Björk J, Jakobsson K. Asthma incidence in children growing up close to traffic: a registry-based birth cohort. Environ Health 2013; 12:91. [PMID: 24160449 PMCID: PMC4016196 DOI: 10.1186/1476-069x-12-91] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 10/23/2013] [Indexed: 05/25/2023]
Abstract
BACKGROUND Recent reviews conclude an association between traffic-related pollution and incidence of asthma in children, but not all studies agree. Studies have almost exclusively relied on parental-reported symptoms or parental-reported diagnoses of asthma and wheeze. Our aim was to investigate if traffic exposure is associated with higher incidence of early onset asthma, using registry-based outcome data. METHODS We investigated a birth cohort in southern Sweden, consisting of N = 26,128 children with outcome and exposure data (born July 2005-2010). Of these children, N = 7898 had additional covariate information. The cohort was followed to the end of 2011.Traffic intensity, and dispersion-modeled concentrations of NOX (100×100 m grid), at residential addresses, were linked with registry data on dispensed asthma medication (the Swedish Prescribed Drug Register), and hospital and primary health care diagnoses of bronchiolitis, obstructive bronchitis and asthma (The Scania Health Care Register).Covariate information was obtained from questionnaires distributed to parents at Child Health Care-centre visits, eight months after birth. Cox proportional hazards regression was used for the statistical analyses. RESULTS Living in close proximity to a road with ≥8640 cars/day (compared to 0-8640 cars/day), was not associated with higher incidence of first purchase of inhaled β2-agonist (adjusted hazard ratio (adj.HR) = 0.9, 95% CI: 0.8-1.0); third year purchase of inhaled β2-agonist (adj.HR = 0.7, 95% CI: 0.6-0.9); bronchiolitis (adj.HR = 0.7, 95% CI: 0.6-0.9), obstructive bronchitis (adj.HR = 1.0, 95% CI: 0.9-1.2), or asthma (adj.HR = 0.7, 95% CI: 0.6- 0.9). Similar results were found for inhaled corticosteroids, and in relation to NOX. CONCLUSIONS Traffic-related exposure was not associated with higher incidence of asthma medication, or diagnoses of asthma, bronchiolitis, or obstructive bronchitis, in children 0-6 years in southern Sweden. This may depend on the low levels of traffic pollution in the area, mainly well below the WHO-guideline for NO2.
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Affiliation(s)
- Anna Lindgren
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Emilie Stroh
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Jonas Björk
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Kristina Jakobsson
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
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Örtqvist AK, Lundholm C, Wettermark B, Ludvigsson JF, Ye W, Almqvist C. Validation of asthma and eczema in population-based Swedish drug and patient registers. Pharmacoepidemiol Drug Saf 2013; 22:850-60. [PMID: 23754713 DOI: 10.1002/pds.3465] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 04/02/2013] [Accepted: 04/29/2013] [Indexed: 11/08/2022]
Abstract
PURPOSE Validated measures of asthma and eczema at the population level remain a challenge. Our aim was to ascertain if register-based information on asthma/eczema medication can function as a proxy for an asthma/eczema diagnosis and to validate register-based asthma diagnoses. METHODS Information was requested on all 0-45-year-old individuals with reported asthma/eczema medication and/or diagnoses in the Swedish Prescribed Drug Register and National Patient Register, between July 2005 and December 2009 (N = 250 691). Medical records for 1952 randomly selected individuals were reviewed to estimate the proportion of individuals with the following: (1) asthma/eczema medication that fulfilled predefined criteria of asthma/eczema (positive predictive value (PPV)) and (2) a register-based asthma diagnosis verified as asthma by predefined criteria. RESULTS Positive predictive value for asthma by predefined criteria ranged between 0.75 (95%CI: 0.70-0.78) to 0.94 (95%CI: 0.91-0.96), depending on age group. In pre-school children, PPV for asthma in combination with obstructive bronchitis was 0.87 (95%CI: 0.83-0.90), and PPV for eczema was estimated to 0.45 (95%CI: 0.38-0.51). Eighty percent of children 0-4.5 years and 99% of children >4.5-17 years with a register-based diagnosis of asthma were verified as asthmatics. CONCLUSION Asthma medication is a suitable proxy for asthma in older children and adults; the same approach is insufficient for eczema. This validation study of two Swedish registers opens for future large nation-wide register-based studies on asthma.
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Affiliation(s)
- Anne K Örtqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Arshad SH, Dharmage SC, Ferreira F, Fixman ED, Gadermaier G, Hauser M, Sampson AP, Teran LM, Wallner M, Wardlaw AJ. Developments in the field of allergy in 2011 through the eyes of Clinical and Experimental Allergy. Clin Exp Allergy 2013. [PMID: 23181787 DOI: 10.1111/cea.12037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
As in previous years, we felt it would be of value to our readership to summarize the new information provided by the authors who have published in Clinical and Experimental Allergy in 2011 and set this in the context of recent advances in our understanding of the pathogenesis and management of allergic disease in all its many manifestations. In 2011, about 210 articles were published in Clinical and Experimental Allergy including editorials, reviews, opinion articles, guidelines, letters, book reviews and of course at the heart of the journal, papers containing original data. As before, this review is divided into sections based on the way the journal is structured, although this year we have grouped together all the papers dealing with mechanisms of allergic disease, whether they involve patients (clinical mechanisms), pure in vitro studies (basic mechanisms) or animal models (experimental models), as we felt this was a more coherent way to deal with the subject. In the field of asthma and rhinitis, the relationship between airway inflammation and airway dysfunction was of perennial interest to investigators, as were phenotypes and biomarkers. Aspirin hypersensitivity appeared in studies in several papers and there was new interest in asthma in the elderly. The mechanisms involved in allergic disease describe advances in our understanding of T cell responses, the relationship between inflammation and disease, mast cell and basophil activation, steroid resistance and novel therapies. In the section dealing with epidemiology, studies seeking to identify risk factors for allergic disease including vitamin D are prominent, as once again are studies investigating gene-environment interactions. The clinical allergy section focuses on drug allergy, food allergy and immunotherapy. The area of oral immunotherapy for food allergy is well covered and we were grateful to Stephen Durham for guest editing an outstanding special issue on immunotherapy in the centenary year of Leonard Noon's pioneering work. Lastly, in the field of allergens, the interest in component-resolved diagnosis continues to grow and there are also articles describing important novel cultivars and the effect of food processing on the allergenic properties of foods. Another terrific year, full of important and high-quality work,which the journal has been proud to bring to the allergy community.
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Affiliation(s)
- S H Arshad
- David Hide Asthma and Allergy Research Centre, Isle of Wight, UK
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Kumar R, Nguyen EA, Roth LA, Oh SS, Gignoux CR, Huntsman S, Eng C, Moreno-Estrada A, Sandoval K, Peñaloza-Espinosa RI, López-López M, Avila PC, Farber HJ, Tcheurekdjian H, Rodriguez-Cintron W, Rodriguez-Santana JR, Serebrisky D, Thyne SM, Williams LK, Winkler C, Bustamante CD, Pérez-Stable EJ, Borrell LN, Burchard EG. Factors associated with degree of atopy in Latino children in a nationwide pediatric sample: the Genes-environments and Admixture in Latino Asthmatics (GALA II) study. J Allergy Clin Immunol 2013; 132:896-905.e1. [PMID: 23684070 DOI: 10.1016/j.jaci.2013.02.046] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 12/05/2012] [Accepted: 02/07/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atopy varies by ethnicity, even within Latino groups. This variation might be due to environmental, sociocultural, or genetic factors. OBJECTIVE We sought to examine risk factors for atopy within a nationwide study of US Latino children with and without asthma. METHODS Aeroallergen skin test responses were analyzed in 1830 US Latino subjects. Key determinants of atopy included country/region of origin, generation in the United States, acculturation, genetic ancestry, and site to which subjects migrated. Serial multivariate zero-inflated negative binomial regressions stratified by asthma status examined the association of each key determinant variable with the number of positive skin test responses. In addition, the independent effect of each key variable was determined by including all key variables in the final models. RESULTS In baseline analyses African ancestry was associated with 3 times (95% CI, 1.62-5.57) as many positive skin test responses in asthmatic participants and 3.26 times (95% CI, 1.02-10.39) as many positive skin test responses in control participants. Generation and recruitment site were also associated with atopy in crude models. In final models adjusted for key variables, asthmatic patients of Puerto Rican (exp[β] [95% CI], 1.31 [1.02-1.69]) and mixed (exp[β] [95% CI], 1.27 [1.03-1.56]) ethnicity had a greater probability of positive skin test responses compared with Mexican asthmatic patients. Ancestry associations were abrogated by recruitment site but not region of origin. CONCLUSIONS Puerto Rican ethnicity and mixed origin were associated with degree of atopy within US Latino children with asthma. African ancestry was not associated with degree of atopy after adjusting for recruitment site. Local environment variation, represented by site, was associated with degree of sensitization.
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Affiliation(s)
- Rajesh Kumar
- Division of Allergy and Immunology, Children's Memorial Hospital, and the Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Ill.
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