1
|
Cameron E, Mo J, Yu C. A health inequality analysis of childhood asthma prevalence in urban Australia. J Allergy Clin Immunol 2024; 154:285-296. [PMID: 38483422 DOI: 10.1016/j.jaci.2024.01.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 01/12/2024] [Accepted: 01/18/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND Long-standing health inequalities in Australian society that were exposed by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic were described as "fault lines" in a recent call to action by a consortium of philanthropic organizations. With asthma a major contributor to childhood disease burden, studies of its spatial epidemiology can provide valuable insights into the emergence of health inequalities early in life. OBJECTIVE The aims of this study were to characterize the spatial variation of asthma prevalence among children living within Australia's 4 largest cities and quantify the relative contributions of climatic and environmental factors, outdoor air pollution, and socioeconomic status in determining this variation. METHODS A Bayesian model with spatial smoothing was developed to regress ecologic health status data from the 2021 Australian Census against groups of explanatory covariates intended to represent mechanistic pathways. RESULTS The prevalence of asthma in children aged 5 to 14 years averages 7.9%, 8.2%, 8.5%, and 7.6% in Sydney, Melbourne, Brisbane, and Perth, respectively. This small inter-city variation contrasts against marked intracity variation at the small-area level, which ranges from 6% to 12% between the least and most affected locations in each. Statistical variance decomposition on a subsample of Australian-born, nonindigenous children attributes 66% of the intracity spatial variation to the assembled covariates. Of these covariates, climatic and environmental factors contribute 30%, outdoor air pollution contributes 19%, and areal socioeconomic status contributes the remaining 51%. CONCLUSION Geographic health inequalities in the prevalence of childhood asthma within Australia's largest cities reflect a complex interplay of factors, among which socioeconomic status is a principal determinant.
Collapse
Affiliation(s)
- Ewan Cameron
- School of Population Health, Curtin University, Bentley, Australia; Geospatial Health and Development, Telethon Kids Institute, Nedlands, Australia.
| | - Joyce Mo
- Geospatial Health and Development, Telethon Kids Institute, Nedlands, Australia
| | - Charles Yu
- Geospatial Health and Development, Telethon Kids Institute, Nedlands, Australia
| |
Collapse
|
2
|
Park M, Han MA, Park J, Choi SW. Effects of changes in daily life attributed to COVID-19 on allergic diseases among Korean adolescents. J Asthma 2024:1-9. [PMID: 38850521 DOI: 10.1080/02770903.2024.2366525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/05/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVE The daily lives of adolescents have changed significantly because of COVID-19 pandemic. We investigated the effects of changes in daily life attributed to COVID-19 on allergic diseases among Korean adolescents. METHODS Data from the 2021 Korea Youth Risk Behavior Survey were used. In total, 54,848 survey participants were included in the analysis. Allergic diseases included allergic rhinitis, atopic dermatitis, and asthma. Changes attributed to COVID-19 included family economic difficulties, physical activity, breakfast skipping frequency, alcohol consumption, smoking, and depressive moods. Chi-square tests and multiple logistic regression analyses were conducted to examine the impact of changes in daily life attributed to COVID-19 on allergic diseases. RESULTS Among the Korean adolescents surveyed, 29.8% experienced a deterioration in their economic status due to COVID-19, 49.1% reported decreased physical activity, 2.8% reported increased alcohol consumption, 1.0% reported an increase in their smoking behavior, and 36.9% reported an increase in depressive moods. Those diagnosed with atopic dermatitis, allergic rhinitis, or asthma within the previous 12 months accounted for 17.1%, 6.2%, and 1.0% of the population, respectively. Adolescents who were significantly affected by COVID-19 in their daily lives were frequently diagnosed with allergic diseases within the last 12 months. CONCLUSION Changes in daily life due to COVID-19, including decreased physical activity and increased depressive mood, were common in adolescents and were associated with an increased prevalence of allergic diseases. Since changes in daily life due to the pandemic may increase the burden of allergic disease, additional interventions for disease management should be considered.
Collapse
Affiliation(s)
- Miso Park
- Department of Public Health, Graduate School of Health Science, Chosun University, Gwangju, Republic of Korea
| | - Mi Ah Han
- Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Jong Park
- Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Seong Woo Choi
- Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
| |
Collapse
|
3
|
Yang-Huang J, McGrath JJ, Gauvin L, Nikiéma B, Spencer NJ, Awad YA, Clifford S, Markham W, Mensah F, Andersson White P, Ludvigsson J, Faresjö T, Duijts L, van Grieken A, Raat H. Early family socioeconomic status and asthma-related outcomes in school-aged children: Results from seven birth cohort studies. J Epidemiol Community Health 2024:jech-2023-220726. [PMID: 38849153 DOI: 10.1136/jech-2023-220726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 12/27/2023] [Indexed: 06/09/2024]
Abstract
OBJECTIVE To examine the associations between maternal education and household income during early childhood with asthma-related outcomes in children aged 9-12 years in the UK, the Netherlands, Sweden, Australia, the USA and Canada. METHODS Data on 31 210 children were obtained from 7 prospective birth cohort studies across six countries. Asthma-related outcomes included ever asthma, wheezing/asthma attacks and medication control for asthma. Relative social inequalities were estimated using pooled risk ratios (RRs) adjusted for potential confounders (child age, sex, mother ethnic background and maternal age) for maternal education and household income. The Slope Index of Inequality (SII) was calculated for each cohort to evaluate absolute social inequalities. RESULTS Ever asthma prevalence ranged from 8.3% (Netherlands) to 29.1% (Australia). Wheezing/asthma attacks prevalence ranged from 3.9% (Quebec) to 16.8% (USA). Pooled RRs for low (vs high) maternal education and low (vs high) household income were: ever asthma (education 1.24, 95% CI 1.13 to 1.37; income 1.28, 95% CI 1.15 to 1.43), wheezing/asthma attacks (education 1.14, 95% CI 0.97 to 1.35; income 1.22, 95% CI 1.03 to 1.44) and asthma with medication control (education 1.16, 95% CI 0.97 to 1.40; income 1.25, 95% CI 1.01 to 1.55). SIIs supported the lower risk for children with more highly educated mothers and those from higher-income households in most cohorts, with few exceptions. CONCLUSIONS Social inequalities by household income on the risk of ever asthma, wheezing/asthma attacks, and medication control for asthma were evident; the associations were attenuated for maternal education. These findings support the need for prevention policies to address the relatively high risks of respiratory morbidity in children in families with low socioeconomic status.
Collapse
Affiliation(s)
- Junwen Yang-Huang
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Lise Gauvin
- Centre de recherche, Centre Hospitalier de L'Universite de Montreal, Montreal, Quebec, Canada
- École de santé publique, Université de Montréal, Montreal, Quebec, Canada
| | - Beatrice Nikiéma
- Department of Program Development and Support, Cree Board of Health and Social Services of James Bay, Chisasibi, Quebec, Canada
| | - Nicholas James Spencer
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Yara Abu Awad
- PERFORM Centre, Concordia University, Montreal, Quebec, Canada
| | - Susan Clifford
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Wolfgang Markham
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Fiona Mensah
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Pär Andersson White
- Department of Health, Medicine and Care, General Practice, Linköping University, Linköping, Sweden
- Crown Princess Victoria Children's Hospital and Division of Pediatrics, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Johnny Ludvigsson
- Crown Princess Victoria Children's Hospital and Division of Pediatrics, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Tomas Faresjö
- Department of Health, Medicine and Care, General Practice, Linköping University, Linköping, Sweden
| | - Liesbeth Duijts
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
- Division of Neonatology, Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Amy van Grieken
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
4
|
Omura M, Cortese S, Bailhache M, Navarro MC, Melchior M, van der Waerden J, Heude B, de Lauzon-Guillain B, Galera C. Associations between symptoms of attention-deficit hyperactivity disorder, socioeconomic status and asthma in children. NPJ MENTAL HEALTH RESEARCH 2024; 3:22. [PMID: 38627466 PMCID: PMC11021421 DOI: 10.1038/s44184-024-00064-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/15/2024] [Indexed: 04/19/2024]
Abstract
Socioeconomic status (SES) influences the risk of both physical diseases, such as asthma, and neurodevelopmental conditions, including attention-deficit/hyperactivity disorder (ADHD). Using Causal Mediation Analysis on French birth-cohort data, we found a causal pathway from SES to ADHD symptoms, in part mediated by asthma. An increase in family income at age 3 by one unit resulted in lower ADHD symptoms at age 5, by -0.37 [95% CI: -0.50, -0.24] SDQ-score-points, with additional -0.04 [95% CI: -0.08, -0.01] points reduction indirectly via asthma at age 3, both with statistical significance. Importantly, family income at age 3 exerted both direct and indirect (via asthma) negative effects on later ADHD symptoms with much higher magnitudes for the direct effect. Our findings underscore the importance of apprehending ADHD symptoms in the broader context of socioeconomic disparities, along with their comorbidities with asthma, potentially influencing public health interventions and clinical practice in managing ADHD.
Collapse
Affiliation(s)
- Makiko Omura
- Department of Economics, Faculty of Economics, Meiji Gakuin University, Minato-ku, Tokyo, Japan.
- Institut de Santé Publique d'Epidémiologie et de Développement, Université de Bordeaux, Bordeaux, France.
| | - Samuele Cortese
- Center for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, NY, USA
- DiMePRe-J-Department of Precision and Regenerative Medicine-Jonic Area, University "Aldo Moro", Bari, Italy
| | - Marion Bailhache
- Centre Hospitalier Universitaire de Bordeaux-Urgences Pédiatriques, Bordeaux, France
- INSERM, Bordeaux Population Health Centre, UMR1219, Bordeaux, France
| | - Marie C Navarro
- Institut de Santé Publique d'Epidémiologie et de Développement, Université de Bordeaux, Bordeaux, France
- INSERM, Bordeaux Population Health Centre, UMR1219, Bordeaux, France
| | - Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), UMR S 1136, Équipe de Recherche en Épidémiologie Sociale, F-75012, Paris, France
| | - Judith van der Waerden
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), UMR S 1136, Équipe de Recherche en Épidémiologie Sociale, F-75012, Paris, France
| | - Barbara Heude
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM, INRAE, Center for Research in Epidemiology and Statistics (CRESS), F-75004, Paris, France
| | - Blandine de Lauzon-Guillain
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM, INRAE, Center for Research in Epidemiology and Statistics (CRESS), F-75004, Paris, France
| | - Cédric Galera
- Institut de Santé Publique d'Epidémiologie et de Développement, Université de Bordeaux, Bordeaux, France
- INSERM, Bordeaux Population Health Centre, UMR1219, Bordeaux, France
- Centre Hospitalier Perrens, Bordeaux, France
- Research Unit on Children's Psychosocial Maladjustment, Montreal, QC, Canada
| |
Collapse
|
5
|
Hoffmann SS, Thiesson EM, Johansen JD, Hviid A. Association between atopic disease and vaccination granulomas: A nested case-control study. Contact Dermatitis 2024; 90:411-419. [PMID: 38059542 DOI: 10.1111/cod.14472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/16/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Vaccination granulomas are observed in 1% of all children vaccinated with an aluminium-adsorbed vaccine. Most children with granulomas also have aluminium contact allergy (CA). CA and atopic diseases are both highly prevalent among children and may be associated. OBJECTIVE To investigate the association between vaccination granulomas and atopic dermatitis (AD), asthma and rhinitis in children. METHODS We sourced a cohort of all Danish children born from 2009 to 2017 and conducted a nested case-control study, with cases defined as children with vaccination granulomas, matched to controls 1:10 on sex, socioeconomic class, gestational age and season of birth. All cases and controls were vaccinated with aluminium-adsorbed vaccines and followed until their second birthday. We used conditional logistic regression to estimate the odds ratios (ORs). RESULTS The study included 2171 cases with vaccination granulomas, and 21 710 controls. Children with a diagnosis of AD had a significantly higher risk of a vaccination granuloma (OR 1.50, 95% confidence intervals [CI] 1.25-1.80). No significant association was found between granulomas and asthma or rhinitis. The association between granulomas and AD was even higher in an additional sensitivity-analysis, following the children until their fourth birthday (OR 2.71, 95% CI 2.36-3.11). CONCLUSION AD was significantly associated with vaccination granulomas, but not with other atopic diseases, within both the first 2 and 4 years of life.
Collapse
Affiliation(s)
- Stine Skovbo Hoffmann
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | | | - Jeanne Duus Johansen
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Anders Hviid
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
- Pharmacovigilance Research Center, Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
6
|
To T, Borkhoff CM, Anderson LN, Birken CS, Dell SD, Janus M, Maguire JL, Moraes TJ, Parkin PC, Subbarao P, Van Dam A, Guttman B, Terebessy E, Zhang K, Zhu J. Association of factors with childhood asthma and allergic diseases using latent class analysis. Sci Rep 2024; 14:6874. [PMID: 38519555 PMCID: PMC10959981 DOI: 10.1038/s41598-024-56805-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/11/2024] [Indexed: 03/25/2024] Open
Abstract
We hypothesize that children characterized by deprived factors have poorer health outcomes. We aim to identify clustering of determinants and estimate risk of early childhood diseases. This 1993-2019 longitudinal cohort study combines three Canadian pediatric cohorts and their families. Mothers and children are clustered using latent class analysis (LCA) by 16 indicators in three domains (maternal and newborn; socioeconomic status [SES] and neighbourhood; environmental exposures). Hazard ratios (HR) of childhood asthma, allergic rhinitis (AR), and eczema are quantified with Cox proportional hazard (PH) regression. Rate ratios (RR) of children's health services use (HSU) are estimated with Poisson regression. Here we report the inclusion of 15,724 mother-child pairs; our LCA identifies four mother-clusters. Classes 1 and 2 mothers are older (30-40 s), non-immigrants with university education, living in high SES neighbourhoods; Class 2 mothers have poorer air quality and less greenspace. Classes 3 and 4 mothers are younger (20-30 s), likely an immigrant/refugee, with high school-to-college education, living in lower SES neighborhoods with poorer air quality and less greenspace. Children's outcomes differ by Class, in comparison to Class 1. Classes 3 and 4 children have higher risks of asthma (HR 1.24, 95% CI 1.11-1.37 and HR 1.39, 95% CI 1.22-1.59, respectively), and similar higher risks of AR and eczema. Children with AR in Class 3 have 20% higher all-cause physician visits (RR = 1.20, 95% CI 1.10-1.30) and those with eczema have 18% higher all-cause emergency department visits (RR = 1.18, 95% CI 1.09-1.28) and 14% higher all-cause physician visits (RR = 1.14, 95% CI 1.09-1.19). Multifactorial-LCA mother-clusters may characterize associations of children's health outcomes and care, adjusting for interrelationships.
Collapse
Affiliation(s)
- Teresa To
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada.
| | - Cornelia M Borkhoff
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, ON, Canada
| | - Laura N Anderson
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Catherine S Birken
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, ON, Canada
| | - Sharon D Dell
- Division of Respiratory Medicine, Department of Pediatrics, BC Children's Hospital and University of British Columbia, Vancouver, BC, Canada
| | - Magdalena Janus
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Jonathon L Maguire
- The Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
| | - Theo J Moraes
- Department of Pediatrics, Translational Medicine, Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Patricia C Parkin
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, ON, Canada
| | - Padmaja Subbarao
- Department of Pediatrics, Translational Medicine, Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Anne Van Dam
- Knowledge Mobilization, Canadian Thoracic Society, Ottawa, ON, Canada
| | - Beverly Guttman
- Provincial Council for Maternal and Child Health, Toronto, ON, Canada
| | - Emilie Terebessy
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada
| | - Kimball Zhang
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada
| | - Jingqin Zhu
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada
| |
Collapse
|
7
|
Gebresillasie TG, Worku A, Ahmed AA, Kabeta ND. Determinants of asthma among adults in Tigray, Northern Ethiopia: a facility-based case-control study. PeerJ 2024; 12:e16530. [PMID: 38192600 PMCID: PMC10773448 DOI: 10.7717/peerj.16530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/06/2023] [Indexed: 01/10/2024] Open
Abstract
Background Asthma is a public health concern affecting millions of productive age groups. Several studies were conducted on the determinants of asthma in children. However, little is known about the determinants of asthma among adults in Ethiopia. Understanding the determinants of asthma among adults can help reduce its burden. This study was aimed at identifying determinant factors for developing asthma among adults in Tigray hospitals. Methods A facility-based, unmatched case-control study design was conducted from January 1 to April 26, 2019. A total of 698 participants (228 cases and 470 controls) completed their guided interviews using structured and pretested questionnaires by trained data collectors. A modified standard questionnaire from the European Community Respiratory Health Survey II (ECRHS II) was used to collect the data. The case definition was patients having asthma, and the control definition was patients without asthma. Data were entered and cleaned using Epi Data Manager Version 3.1 software and imported to statistical packages for social sciences Version 25 software for analysis. To identify asthma determinants, bivariate and multivariable logistic regression models were fitted. Results The response rate for both cases and controls was 95.9%. The odds of developing asthma was nearly twice higher among those who resided in urban (AOR = 1.68; 95% CI [1.13-2.50]), more than twice higher among those who have income less than 1000 ETB (AOR = 2.3; 95% CI [1.17-4.56]), twice higher among those who had history of skin allergy (AOR = 2.09; 95% CI [1.14-3.86]), over four times higher among those with family history of asthma (AOR = 4.26; 95% CI [2.63-6.91]), three times higher among those having house dust or smoke exposure (AOR = 3.01; 95% CI [1.96-4.64]), over five times higher among those lifetime firewood users (AOR = 5.39; 95% CI [3.34-8.72]), door opening while cooking (AOR = 0.35; 95% CI [0.26-0.55]), nearly two times higher among those having house dampness (AOR = 1.98; 95% CI [1.069-3.68]), over seven times higher among pet owners (AOR = 7.46; 95% CI [4.04-13] and almost twice higher among those who were physically inactive (AOR = 1.75; 95% CI [1.11-2.85]). Conclusion Asthma has been associated with urbanization, low income, a history of allergic diseases, indoor smoke or dust, firewood use, pet ownership, and a sedentary lifestyle. The community should be informed about the known risks and implement preventive steps like opening a door while cooking to lower the risk of asthma.
Collapse
Affiliation(s)
- Tirhas G. Gebresillasie
- Department of Public Health, College of Health Sciences, Aksum University, Axum, Tigray, Ethiopa
- School of Public Health, College of Medicine and Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- School of Public Health, College of Medicine and Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ahmed Ali Ahmed
- School of Public Health, College of Medicine and Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Negussie Deyessa Kabeta
- School of Public Health, College of Medicine and Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| |
Collapse
|
8
|
Renzi-Lomholt M, Ulrik CS, Rastogi D, Stæhr Jensen JU, Håkansson KEJ. Impact of family socioeconomic position on childhood asthma outcomes, severity, and specialist referral - a Danish nationwide study. Chron Respir Dis 2024; 21:14799731241231816. [PMID: 38378166 PMCID: PMC10880522 DOI: 10.1177/14799731241231816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/20/2023] [Accepted: 01/22/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Asthma is the most common chronic illness in children, carrying a major burden. Socioeconomic position (SEP) affects adult asthma outcomes, but its impact on childhood asthma, particularly in primary versus specialist care, has not been studied thoroughly. METHODS In a Danish cohort consisting of all children aged 2-17 years redeeming inhaled corticosteroids in 2015, parental SEP impact on asthma outcomes was investigated. Workforce attachment, income, education, and metropolitan residence were chosen as covariates in logistic regression. Outcomes were uncontrolled (excessive use of short-acting beta2-agonists), exacerbating (oral corticosteroid use or hospitalization), and severe asthma (according to GINA 2020). RESULTS The cohort comprised 29,851 children (median age 8.0, 59% boys). 16% had uncontrolled asthma, 8% had ≥1 exacerbation. Lower income and metropolitan residence correlated with higher odds of poor control, exacerbations, and severe asthma. Lower education correlated with worse asthma outcomes. Education and income were protective factors in primary care, but not in specialist care. Metropolitan residence was the sole factor linked to specialist care referral for severe asthma. CONCLUSION Low parental SEP and metropolitan residence associated with poor asthma outcomes. However, specialist care often mitigated these effects, though such care was less likely for at-risk children in non-metropolitan areas.
Collapse
Affiliation(s)
- Martino Renzi-Lomholt
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Deepa Rastogi
- Division of Pulmonary and Sleep Medicine, Children’s National Health System, Washington, DC, USA
- Pediatrics, Genomics and Precision Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Jens Ulrik Stæhr Jensen
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Respiratory Section, Department of Internal Medicine, Copenhagen University Hospital - Gentofte, Gentofte, Denmark
| | | |
Collapse
|
9
|
Janus M, Reid-Westoby C, Pottruff M, Schneeweiss M, Hu G, Brownell M. Developmental health of Canadian kindergarten children with teacher-reported asthma between 2010 and 2015: A population-level cross-sectional study. Prev Med Rep 2024; 37:102525. [PMID: 38186657 PMCID: PMC10767499 DOI: 10.1016/j.pmedr.2023.102525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/17/2023] [Accepted: 11/21/2023] [Indexed: 01/09/2024] Open
Abstract
Asthma can impact children's quality of life. It is unclear how asthma is associated with the developmental health (i.e. a broad range of skills and abilities associated with growth and development) of young children at school entry. The goals of this cross-sectional, population-level study were to: (1) investigate the association between teacher-reported asthma and children's concurrent indicators of developmental health (developmental vulnerability); and (2) explore whether school absences and functional impairments modified this association. Participants were a Canadian population-based sample of 564 582 kindergarten children (Mage = 5.71 years, SD = 0.32, 51.3 % male) with data on the Early Development Instrument (EDI) collected between 2010 and 2015. Adjusted binary logistic regressions were conducted to address the objectives. From the sample, 958 (0.2 %) children were identified as having a diagnosis of asthma. These children were absent on average 9.4 days and 53.5 % had functional impairments (vs. 6.7 days absent and 15.9 % with functional impairments in children without asthma). After controlling for demographic characteristics, children with asthma had between 1.51 and 2.42 higher odds of being developmentally vulnerable. Only the presence of functional impairments modified this relationship and only for physical health and well-being. In this large, population-based sample of Canadian kindergarten children, few teachers reported knowledge of their students' asthma diagnosis. Among teacher-reported cases, asthma was a risk factor for developmental vulnerability in the domain of physical health and well-being only. Functional impairments may therefore be more detrimental for child development at school entry than asthma alone.
Collapse
Affiliation(s)
- Magdalena Janus
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario L8S 4K1, Canada
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
| | - Caroline Reid-Westoby
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario L8S 4K1, Canada
| | - Molly Pottruff
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario L8S 4K1, Canada
| | - Michelle Schneeweiss
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada
| | - George Hu
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada
| | - Marni Brownell
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba R3E 3P5, Canada
| | - Canadian Children's Health in Context Study Team
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario L8S 4K1, Canada
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba R3E 3P5, Canada
| |
Collapse
|
10
|
Jenkins CR, Singh D, Ducharme FM, Raherison C, Lavoie KL. Asthma and Rhinitis Through the Lifespan of Nonpregnant Women. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3578-3584. [PMID: 37802256 DOI: 10.1016/j.jaip.2023.09.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/22/2023] [Accepted: 09/28/2023] [Indexed: 10/08/2023]
Abstract
Increasingly, clinical practice guidelines advocate a precision medicine-based approach to care for asthma. This focus requires knowledge of not only different asthma phenotypes and their associated biomarkers but also sex and gender differences through the lifespan. Evidence continues to build in favor of different lifetime prevalence, clinical presentations, responses to management, and long-term prognosis of asthma. Women transition through many biological and psychosocial phases in their lives, all of which may interact with, and influence, their health and well-being. Historically, explanations have focused on hormonal effects on asthma in reproductive life, but a greater understanding of mechanisms starting before birth and changing over a lifetime is now possible, with immunologic, inflammatory, and hormonal factors playing a role. This article describes the evidence for the differences in asthma and rhinitis between men and women at different stages of life, the potential underlying mechanisms that contribute to this, and the implications for management and research. Future research studies should systematically report sex differences in asthma so that this knowledge can be used to develop a personalized approach to care, to achieve best possible outcomes for all.
Collapse
Affiliation(s)
| | - Dave Singh
- Medicines Evaluation Unit, Manchester University, Manchester, United Kingdom; NHS Foundation Trust, University of Manchester, Manchester, United Kingdom
| | - Francine M Ducharme
- Department of Pediatrics, University of Montréal, Montréal, QC, Canada; Department of Social and Preventive Medicine, School of Public Health, University of Montréal, Montréal, QC, Canada
| | - Chantal Raherison
- Department of Pulmonology, CHU Guadeloupe, French West Indies University, Guadeloupe, French West Indies
| | - Kim L Lavoie
- Department of Psychology, University of Quebec at Montréal (UQAM), Montréal, QC, Canada; Montréal Behavioural Medicine Centre (MBMC), CIUSSS-NIM, Hopital du Sacre-Coeur de Montreal, Montréal, QC, Canada
| |
Collapse
|
11
|
Oh CM, Lee S, Kwon H, Hwangbo B, Cho H. Prevalence of pre-existing lung diseases and their association with income level among patients with lung cancer: a nationwide population-based case-control study in South Korea. BMJ Open Respir Res 2023; 10:e001772. [PMID: 37940354 PMCID: PMC10632895 DOI: 10.1136/bmjresp-2023-001772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 10/13/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND This study aimed to estimate the prevalence of pre-existing lung diseases in patients with lung cancer compared to people without lung cancer and examine the association between income levels and pre-existing lung diseases. METHODS Data on patients with lung cancer (case) and the general population without lung cancer (non-cancer controls) matched by age, sex and region were obtained from the Korea National Health Insurance Service-National Health Information Database (n=51 586). Insurance premiums were divided into quintiles and medicaid patients. Conditional logistic regression models were used to examine the association between pre-existing lung diseases and the risk of lung cancer. The relationship between income level and the prevalence of pre-existing lung disease among patients with lung cancer was analysed using logistic regression models. RESULTS The prevalence of asthma (17.3%), chronic obstructive lung disease (COPD) (9.3%), pneumonia (9.1%) and pulmonary tuberculosis (1.6%) in patients with lung cancer were approximately 1.6-3.2 times higher compared with the general population without lung cancer. A significantly higher risk for lung cancer was observed in individuals with pre-existing lung diseases (asthma: OR=1.36, 95% CI 1.29 to 1.44; COPD: 2.11, 95% CI 1.94 to 2.31; pneumonia: 1.49, 95% CI 1.38 to 1.61; pulmonary tuberculosis: 2.16, 95% CI 1.75 to 2.66). Patients with lung cancer enrolled in medicaid exhibited higher odds of having pre-existing lung diseases compared with those in the top 20% income level (asthma: OR=1.75, 95% CI 1.56 to 1.96; COPD: 1.91, 95% CI 1.65 to 2.21; pneumonia: 1.73, 95% CI 1.50 to 2.01; pulmonary tuberculosis: 2.45, 95% CI 1.78 to 3.36). CONCLUSIONS Pre-existing lung diseases were substantially higher in patients with lung cancer than in the general population. The high prevalence odds of pre-existing lung diseases in medicaid patients suggests the health disparity arising from the lowest income group, underscoring a need for specialised lung cancer surveillance.
Collapse
Affiliation(s)
- Chang-Mo Oh
- Departments of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Sanghee Lee
- Department of Cancer Control and Population Health, National Cancer Center, Goyang, Gyeonggi-do, South Korea
- Health Insurance Research Institute, National Health Insurance Service, Wonju, Gangwon-do, South Korea
| | - Hoejun Kwon
- Department of Cancer Control and Population Health, National Cancer Center, Goyang, Gyeonggi-do, South Korea
| | - Bin Hwangbo
- Division of Pulmonology, Center for Lung Cancer, National Cancer Center, Goyang, Gyeonggi-do, South Korea
| | - Hyunsoon Cho
- Department of Cancer AI and Digital Health, National Cancer Center, Goyang, Gyeonggi-do, South Korea
- Integrated Biostatistics Branch, Division of Cancer Data Science, National Cancer Center, Goyang, Gyeonggi-do, South Korea
| |
Collapse
|
12
|
Shah P, Skjei K. Health Disparities for Immigrant Children: Focus on Epilepsy. Pediatr Ann 2023; 52:e373-e380. [PMID: 37820703 DOI: 10.3928/19382359-20230829-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Although health and health care disparities between immigrant and native-born adult populations in the United States are well documented, the pediatric literature is limited. Data suggest first- and second- generation immigrant children have worse health outcomes when compared with their native-born counterparts because of factors such as socioeconomic status, insurance and language barriers, authorization status, and bias/xenophobia. This article takes a broad look at existing research regarding health barriers for immigrant children, then focuses on the pediatric epilepsy literature to highlight the complex interplay of these disparity factors. Finally, we review the literature on existing interventions, including language concordance, community-driven educational efforts, and broad-scale policy changes that can be used to promote health equity in pediatric epilepsy and beyond. Research gaps are also identified. [Pediatr Ann. 2023;52(10):e373-e380.].
Collapse
|
13
|
Pike MR, Engel ML, Lipner E, Hammen C, Brennan PA. Prenatal Maternal Stress and Pediatric Asthma Across Development: Adolescent Female-Specific Vulnerability. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01600-2. [PMID: 37665402 DOI: 10.1007/s10578-023-01600-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/20/2023] [Indexed: 09/05/2023]
Abstract
Prenatal maternal stress (PNMS) is linked to physical sequelae in offspring, including childhood asthma. This study sought to examine the roles of objective and subjective PNMS in the development of asthma at offspring ages 5 and 15. The sample included 815 mother-child dyads from the Mater Misericordiae Mothers' Hospital-University of Queensland Study of Pregnancy. PNMS was measured via retrospective self-report during pregnancy and 3-5 days after birth. Postnatal maternal stress was measured at offspring age 5. Objective PNMS was associated with elevated asthma risk at age 5 (OR 1.21, 95% CI 1.00, 1.45, p = 0.05), albeit not above concurrent postnatal stress. Sex moderated the association between PNMS and asthma at age 15, controlling for postnatal stress. Sex stratified analyses revealed a positive association between objective PNMS and age 15 asthma in females, but not males. Results provide evidence that PNMS may impact asthma outcomes in adolescence.
Collapse
Affiliation(s)
- Madeline R Pike
- Department of Psychology, Temple University, 1701 N 13th St, Philadelphia, PA, 19122, USA.
| | - Melissa L Engel
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA, 30322, USA
| | - Emily Lipner
- Department of Psychology, Temple University, 1701 N 13th St, Philadelphia, PA, 19122, USA
| | - Constance Hammen
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Los Angeles, CA, 90095, USA
| | - Patricia A Brennan
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA, 30322, USA
| |
Collapse
|
14
|
Nosetti L, Gozal D. Exploring the bidirectional relationship between asthma and obstructive sleep apnea in Brazilian pediatric patients: one more piece to the Puzzle. J Pediatr (Rio J) 2023; 99:423-424. [PMID: 37253428 PMCID: PMC10492138 DOI: 10.1016/j.jped.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Affiliation(s)
- Luana Nosetti
- Insubria University, F. Del Ponte Hospital, Department of Pediatrics, Pediatric Sleep Disorders Center, Varese, Italy
| | - David Gozal
- University of Missouri School of Medicine, Department of Child Health, Child Health Research Institute, Columbia, MO, USA.
| |
Collapse
|
15
|
Kannoth S, Chung SE, Tamakloe KD, Albrecht SS, Azan A, Chambers EC, Sheffield PE, Thompson A, Woo Baidal JA, Lovinsky-Desir S, Stingone JA. Neighborhood environmental vulnerability and pediatric asthma morbidity in US metropolitan areas. J Allergy Clin Immunol 2023; 152:378-385.e2. [PMID: 36990323 PMCID: PMC10524145 DOI: 10.1016/j.jaci.2023.03.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/13/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Research suggests demographic, economic, residential, and health-related factors influence vulnerability to environmental exposures. Greater environmental vulnerability may exacerbate environmentally related health outcomes. We developed a neighborhood environmental vulnerability index (NEVI) to operationalize environmental vulnerability on a neighborhood level. OBJECTIVE We explored the relationship between NEVI and pediatric asthma emergency department (ED) visits (2014-19) in 3 US metropolitan areas: Los Angeles County, Calif; Fulton County, Ga; and New York City, NY. METHODS We performed separate linear regression analyses examining the association between overall NEVI score and domain-specific NEVI scores (demographic, economic, residential, health status) with pediatric asthma ED visits (per 10,000) across each area. RESULTS Linear regression analyses suggest that higher overall and domain-specific NEVI scores were associated with higher annual pediatric asthma ED visits. Adjusted R2 values suggest that overall NEVI scores explained at least 40% of the variance in pediatric asthma ED visits. Overall NEVI scores explained more of the variance in pediatric asthma ED visits in Fulton County. NEVI scores for the demographic, economic, and health status domains explained more of the variance in pediatric asthma ED visits in each area compared to the NEVI score for the residential domain. CONCLUSION Greater neighborhood environmental vulnerability was associated with greater pediatric asthma ED visits in each area. The relationship differed in effect size and variance explained across the areas. Future studies can use NEVI to identify populations in need of greater resources to mitigate the severity of environmentally related outcomes, such as pediatric asthma.
Collapse
Affiliation(s)
- Sneha Kannoth
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY.
| | - Sarah E Chung
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY
| | - Kelvin D Tamakloe
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY
| | - Sandra S Albrecht
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY
| | - Alexander Azan
- Department of Population Health, New York University Langone Health, New York City, NY
| | - Earle C Chambers
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Perry E Sheffield
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Azure Thompson
- Department of Community Health Sciences, School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Jennifer A Woo Baidal
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY
| | - Stephanie Lovinsky-Desir
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY
| | - Jeanette A Stingone
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY
| |
Collapse
|
16
|
Park JC, Nam GE, Yu J, McWhorter KL, Liu J, Lee HS, Lee SS, Han K. Association of Sustained Low or High Income and Income Changes With Risk of Incident Type 2 Diabetes Among Individuals Aged 30 to 64 Years. JAMA Netw Open 2023; 6:e2330024. [PMID: 37603333 PMCID: PMC10442710 DOI: 10.1001/jamanetworkopen.2023.30024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/13/2023] [Indexed: 08/22/2023] Open
Abstract
Importance Evidence of the association between income fluctuation and risk of type 2 diabetes (T2D) is scarce. Objective To investigate whether sustained low or high income and income changes are associated with incidence of T2D. Design, Setting, and Participants In this population-based cohort study, more than 7.8 million adults without T2D aged 30 to 64 years from a nationally representative sample from the Korean Health Insurance Service database were enrolled in 2012 and followed up to 2019 (median follow-up, 6.3 years [IQR, 6.1-6.6 years]). Exposures Twenty quantiles of monthly health insurance premiums determined income levels. Income quartiles were annually analyzed from 2008 to 2012. Beneficiaries of the Medical Aid Program were regarded as those with very low income. A decrease in income was indicated as a reduction of 25% or more in income compared with income in the previous year. Main Outcomes and Measures The primary outcome was incident T2D based on the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes E11 to E14, 1 or more claims of antidiabetic medication, or a fasting glucose level of 126 mg/dL or higher. Multivariable Cox proportional hazards models were used to assess the association of low- or high-income status and income changes with incidence of T2D. Results Of 7 821 227 participants (mean [SD] age, 46.4 [9.3] years; 54.9% men), 359 931 (4.6%) developed T2D at least 1 year after enrollment. Individuals who repeatedly experienced low and very low income for 5 years showed 22% (hazard ratio [HR], 1.22 [95% CI, 1.21-1.23]) and 57% (1.57 [95% CI, 1.53-1.62]) higher T2D risk compared with those who never experienced low and very low income, respectively. In contrast, individuals who were repeatedly in high-income quartiles showed lower T2D risk compared with those who never experienced high income (HR, 0.86 [95% CI, 0.85-0.86]). The number of income decreases was associated with elevated T2D risk (≥2 vs 0 income decreases: HR, 1.08 [95% CI, 1.06-1.11]; P < .001 for trend). When income quartile status was compared between 2008 and 2012, individuals who experienced an income increase had lowered T2D risk, while those who experienced an income decrease had elevated T2D risk in each income quartile group. Conclusions and Relevance This cohort study found that individuals who experienced sustained low-income status or an income decrease had elevated T2D risk, while those who had sustained high-income status or an income increase had lowered T2D risk.
Collapse
Affiliation(s)
| | - Ga Eun Nam
- Department of Family Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Jinna Yu
- Department of Nursing, Chung-Ang University, Seoul, South Korea
| | - Ketrell L. McWhorter
- Department of Epidemiology and Environmental Health, College of Public Health, University of Kentucky, Lexington
| | - Junxiu Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hong Seok Lee
- Division of Cardiology, Banner University Medical Group, Sarver Heart Center, University of Arizona, Tucson
| | - Seong-Su Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea
| |
Collapse
|
17
|
Pumphrey K, Hart J, Kenyon CC. The Role of Hospitalists in Reducing Childhood Asthma Disparities: Time to Step Up? Hosp Pediatr 2023; 13:e195-e198. [PMID: 37288507 PMCID: PMC10312230 DOI: 10.1542/hpeds.2023-007167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Katherine Pumphrey
- Division of General Pediatrics, Section of Hospitalist Medicine
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jessica Hart
- Division of General Pediatrics, Section of Hospitalist Medicine
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Chén C. Kenyon
- Division of General Pediatrics, Section of Hospitalist Medicine
- PolicyLab and Clinical Futures, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| |
Collapse
|
18
|
Lee WS, Hwang JK, Ryu J, Choi YJ, Oh JW, Kim CR, Han MY, Oh IH, Lee KS. The relationship between childhood asthma and socioeconomic status: a Korean nationwide population-based study. Front Public Health 2023; 11:1133312. [PMID: 37181696 PMCID: PMC10167280 DOI: 10.3389/fpubh.2023.1133312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/05/2023] [Indexed: 05/16/2023] Open
Abstract
Purpose This study aimed to investigate associations of socioeconomic status (SES) with asthma exacerbation and asthma-related hospital utilization factors among children with asthma in the Republic of Korea. Methods This study retrospectively analyzed population-level data from the Korean National Health Insurance Service, collected from 2013 through 2019. SES was classified into five categories according to the national health insurance premiums quantiles (0 [lowest] to 4 [highest]). The hazard ratios (HRs) for asthma exacerbation, emergency department (ED) visits, hospital admission, and intensive care unit (ICU) admission were analyzed with respect to SES. Results Among the five SES groups, SES group 0 (medical aid), had the highest tallies and proportions of children who experienced asthma exacerbations (n = 1,682, 4.8%), ED visits (n = 932, 2.6%), hospital admission (n = 2,734, 7.7%) and ICU admission (n = 14, 0.04%). Compared with SES group 4, SES group 0 had adjusted HRs of 3.73 (p = 0.0113) and 1.04 (p < 0.0001) for ventilator support/tracheal intubation and administration of systemic corticosteroids, respectively. Relative to group 4, the adjusted HRs for ED visits, hospital admission, and ICU admission in group 0 were 1.88 (p < 0.0001), 2.20 (p < 0.0001), and 7.12 (p < 0.0001), respectively. In the survival analysis, group 0 had a significantly higher risk of ED presentation, hospital admission, and ICU admission than the other groups (log-rank p < 0.001). Conclusion Compared with children of higher SES, those in the lowest SES group had increased risk of asthma exacerbation, hospital admission, and receiving treatment for severe asthma symptoms.
Collapse
Affiliation(s)
- Won Seok Lee
- Department of Pediatrics, CHA Ilsan Medical Center, CHA University College of Medicine, Goyang, Republic of Korea
| | - Jae Kyoon Hwang
- Department of Pediatrics, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Jiin Ryu
- Biostatistical Consulting and Research Lab, Medical Research Collaborating Center, Hanyang University, Seoul, Republic of Korea
| | - Young-Jin Choi
- Department of Pediatrics, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Jae-Won Oh
- Department of Pediatrics, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Chang-Ryul Kim
- Department of Pediatrics, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Republic of Korea
| | - In Hwan Oh
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Kyung Suk Lee
- Department of Pediatrics, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| |
Collapse
|
19
|
Andersson MA, Wilkinson LR, Schafer MH. The Long Arm of Childhood: Does It Vary According to Health Care System Quality? JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2023; 64:79-97. [PMID: 36062757 DOI: 10.1177/00221465221120099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Increasing evidence points to the salience of early life experiences in shaping health inequalities, but scant research has considered the role of institutional resources as buffers in this relationship. Health care systems in particular are an understudied yet important context for the generation of inequalities from childhood into adulthood. This research investigates associations between childhood disadvantage and adult morbidity and examines the role of health care system quality in this relationship. We also consider the role of adult socioeconomic status. We merge individual-level data on major disease (2014 European Social Survey) with nation-level health care indicators. Results across subjective and objective approaches to health care system quality are similar, indicating a reduced association between childhood socioeconomic status and adult disease in countries with higher quality health care. In total, our results reiterate the long-term influence of childhood disadvantage on health while suggesting health care's specific role as an institutional resource for ameliorating life course health inequalities.
Collapse
|
20
|
Wong QYA, Lim JJ, Ng JY, Malipeddi P, Lim YYE, Sio YY, Chew FT. An updated prevalence of asthma, its phenotypes, and the identification of the potential asthma risk factors among young Chinese adults recruited in Singapore. World Allergy Organ J 2023; 16:100757. [PMID: 36968625 PMCID: PMC10033744 DOI: 10.1016/j.waojou.2023.100757] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 02/01/2023] [Accepted: 02/25/2023] [Indexed: 03/22/2023] Open
Abstract
Background Asthma is a chronic inflammatory disease of the airway characterized by respiratory symptoms: wheezing, shortness of breath, coughing, and chest tightness. Globally, asthma affects over 300 million individuals and carries high morbidity and mortality burden. Previous studies have estimated the prevalence of asthma; however, prevalence estimates have been changing over time. Here, in a population of young Chinese adults from Singapore, we aimed to obtain an updated prevalence of asthma and its phenotypes, and identify potential associated risk factors. Methods The Singapore/Malaysia Cross-Sectional Genetics Epidemiology Study (SMCGES) is an ongoing study which uses established ISAAC guidelines to collect epidemiological data and information pertaining to allergic diseases such as asthma. Responses from young Chinese adults recruited in the National University of Singapore were analyzed. Results Lifetime asthma prevalence rate was estimated at 19.1% (2049/10,736), while current asthma prevalence rate was estimated at 6.3% (679/10,736). For ever asthma, the most important risk factor was a parental history of asthma. Increased consumption of pulses (aOR: 0.822, 95% CI: 0.706-0.958) was associated with a lowered odds of ever asthma, but cereals (aOR: 1.256, 95% CI: 1.006-1.580), pasta (aOR: 1.265, 95% CI: 1.027-1.553), butter (aOR: 1.350, 95% CI: 1.113-1.632), and margarine (aOR: 1.343, 95% CI: 1.081-1.660) were associated with a higher risk of ever asthma. Increased television/computer usage was associated with a decreased risk of ever asthma (aOR: 0.448, 95% CI: 0.367-0.545). Conversely, genetic factors had a lower strength of effect on current asthma (parental history of asthma - OR: 1.465, 95% CI: 1.135-1.888) as compared to ever asthma. Only increased potato consumption was significantly associated with an increased risk of current asthma (most or all days per week vs never or only occasionally - aOR: 1.577, 95% CI: 1.145-2.180). Physical activity (aOR: 0.693, 95% CI: 0.542-0.885) was associated with a lower odds of asthma, while second-hand smoke exposure was associated with an increased risk for current asthma (aOR: 1.435, 95% CI: 1.001-2.047). Conclusion Overall, the prevalence of lifetime asthma and current asthma among young Chinese adults was 19.1% and 6.3%, higher than that of previous studies. Our results suggested a stronger association between genetic factors and ever asthma as compared to current asthma. Parental asthma was the most important intrinsic epidemiological factor for asthma manifestation, while various foods, physical activity levels, and television or computer usage were also significantly associated with asthma. Future studies should consider risk factors in conjunction with other accompanying variables given the potential interactions between them, to discern the effects of environment and lifestyle on asthma more distinctly.
Collapse
|
21
|
Evaluating the Food Allergy Passport: A Novel Food Allergy Clinical Support Tool. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1162-1168.e7. [PMID: 36716996 DOI: 10.1016/j.jaip.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/20/2022] [Accepted: 01/11/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND The prevalence of pediatric food allergy (FA) has increased in the past 2 decades. The previous literature suggests that FA presents burdens, both economically and psychosocially, to children and their caregivers, especially families in lower-income strata. Using data from a previously published needs assessment, the Food Allergy Management in Low-Income Youth study, the FA Passport and Workbook tools were developed to address identified needs. OBJECTIVE This study evaluated the utility of the FA Passport in helping families insured by Medicaid to manage FA better and improve quality of life. METHODS Families insured through Illinois Medicaid were recruited from two Chicago-based allergy clinics. Caregivers of children with FA completed a pretest evaluating knowledge, attitudes, beliefs, and practices regarding FA management. A clinician guided caregivers through the FA Passport. The caregivers then completed a posttest immediately afterward and again 3 months later. Changes were evaluated from baseline responses and direct feedback was elicited about the tool. RESULTS The FA Passport successfully improved caregiver-reported confidence with epinephrine autoinjector use (from 69% to 93%), caregiver anaphylaxis recognition (from 66% to 73%), and reported quality of life, and it nearly doubled caregiver comfort regarding leaving the child in the care of others (from 40% to 75.7%). Caregivers rated the FA Passport tool as extremely helpful overall (9.4 out of 10). CONCLUSIONS The FA Passport is a novel FA clinical support tool that addresses barriers to proper FA management described in previous studies. It proved effective at improving caregiver comfort with regarding leaving the food-allergic children with other caregivers, increasing FA knowledge, and improving the quality of life in families affected by FA.
Collapse
|
22
|
Krings JG, Wojcik KM, Chen V, Sekhar TC, Harris K, Zulich A, Sumino K, Brownson R, Lenze E, Castro M. Symptom-driven inhaled corticosteroid/long-acting beta-agonist therapy for adult patients with asthma who are non-adherent to daily maintenance inhalers: a study protocol for a pragmatic randomized controlled trial. Trials 2022; 23:975. [PMID: 36471430 PMCID: PMC9720948 DOI: 10.1186/s13063-022-06916-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 11/11/2022] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND While inhaled corticosteroids (ICS) are considered the essential foundation of most asthma therapy, ICS inhaler nonadherence is a notoriously common problem and a significant cause of asthma-related morbidity. Partially acknowledging the problem of nonadherence, international organizations recently made paradigm-shifting recommendations that all patients with mild-to-moderate persistent asthma be considered for symptom-driven ICS-containing inhalers rather than relying on adherence to traditional maintenance ICS inhalers and symptom-driven short-acting beta-agonists (SABA). With this new approach, asthma patients are at least exposed to the important anti-inflammatory effects of ICS-containing inhalers when their symptom reliever inhaler is deployed due to acute symptoms. METHODS This study will (Part 1) complete a pragmatic randomized controlled trial to evaluate if an inhaler strategy that utilizes symptom-driven ICS inhalers is particularly beneficial in maintenance ICS inhaler non-adherent asthma patients, and (Part 2) use a dissemination and implementation (D&I) science conceptual framework to better understand patients' and providers' views of inhaler nonadherence. This study, which will have an option of taking place entirely remotely, will use a Food and Drug Administration (FDA)-approved electronic sensor (Hailie® sensor) to monitor inhaler adherence and includes semi-structured interviews guided by the Consolidated Framework for Implementation Research (CFIR). DISCUSSION This study is assessing the problem of nonadherence using a D&I implementation science research lens while testing a new inhaler approach to potentially ameliorate the detrimental consequences of maintenance inhaler nonadherence. We hypothesize that the use of a symptom-driven ICS/LABA management strategy, as compared to traditional maintenance ICS treatment and symptom-driven SABA, will lead to improved adherence to an asthma treatment strategy, decreased asthma-related morbidity, less cumulative ICS exposure, and greater patient satisfaction with an inhaler approach. TRIAL REGISTRATION ClinicalTrials.gov NCT05111262. Registered on November 8, 2021.
Collapse
Affiliation(s)
- James G Krings
- Division of Pulmonary and Critical Care Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, MO, 63110, USA.
| | - Kaitlyn M Wojcik
- Brown School of Social Work and Public Health, Washington University in Saint Louis, Saint Louis, MO, 63110, USA
| | - Vanessa Chen
- Brown School of Social Work and Public Health, Washington University in Saint Louis, Saint Louis, MO, 63110, USA
| | - Tejas C Sekhar
- Division of Pulmonary and Critical Care Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, MO, 63110, USA
| | - Kelly Harris
- Program in Occupational Therapy, Washington University in Saint Louis School of Medicine, Saint Louis, MO, 63110, USA
| | - Abigail Zulich
- Division of Pulmonary and Critical Care Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, MO, 63110, USA
| | - Kaharu Sumino
- Division of Pulmonary and Critical Care Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, MO, 63110, USA
| | - Ross Brownson
- Brown School of Social Work and Public Health, Washington University in Saint Louis, Saint Louis, MO, 63110, USA
| | - Eric Lenze
- Division of Psychiatry, Washington University in Saint Louis School of Medicine, Saint Louis, MO, 63110, USA
| | - Mario Castro
- Division of Pulmonary Critical Care and Sleep Medicine, University of Kansas, Kansas City, KS, 66103, USA
| |
Collapse
|
23
|
Riser QH, Rouse HL, Dorius CJ. Family income trajectories and early child development: A latent class growth analysis. JOURNAL OF APPLIED DEVELOPMENTAL PSYCHOLOGY 2022. [DOI: 10.1016/j.appdev.2022.101469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
24
|
Deka H, Mahanta P, Ahmed SJ, Rajbangshi MC, Konwar R, Basumatari B. Risk Factors of Childhood Asthma Among Patients Attending a Tertiary Care Centre in North-East India. J Asthma Allergy 2022; 15:1293-1303. [PMID: 36132976 PMCID: PMC9482963 DOI: 10.2147/jaa.s374007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/31/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Asthma is a chronic lung illness marked by a reversible airway blockage. Both genetic and environmental factors influence higher asthma rates. The present study aims to assess the various socio-demographic and environmental factors influencing the causation of childhood asthma among patients attending the Paediatric Department of Gauhati Medical College and Hospital (GMCH), Assam. Materials and Methods A total of 150 clinically diagnosed asthma patients of 3–12 years as cases and patients of the same age group free from respiratory diseases with no history of asthma in a 1:1 ratio as controls were selected. A predesigned and pretested proforma was used to collect data, and written informed consent was obtained from all the legal guardians of the participants. Data were analyzed by chi-square test and binary logistic regression using SPSS V20, considering a p-value <0.05 significant. Results Urban and male children were found to be at higher risk of developing asthma. Children belonging to the urban locality (OR= 4.53; 95% CI: 1.57–13.09; p<0.05), damp environment (OR= 5.21; 95% CI: 1.23–22.10; p<0.05), lower socioeconomic status (OR= 3.48; 95% CI: 1.34–9.01; p<0.05), presence of pets (OR= 6.77; 95% CI: 1.76–25.99; p<0.05), family history of atopy/ allergy (OR= 43.29; 95% CI: 5.80–323.15 p<0.05), smoking/passive smoking (OR=23.54; 95% CI: 1.41–394.21 p<0.05) and mixed feeding (OR= 4.47; 95% CI: 1.46–13.63 p<0.05) were the significant risk factors of childhood asthma. Conclusion Children are vulnerable to environmental-induced asthma. Awareness and preventive measures are necessary to control and reduce the burden of childhood asthma.
Collapse
Affiliation(s)
- Himamoni Deka
- Depatment of Anatomy, Gauhati Medical College, Guwahati, Assam, India
| | - Putul Mahanta
- Department of Forensic Medicine and Toxicology, Assam Medical College, Dibrugarh, Assam, India
| | - Sultana Jesmin Ahmed
- Department of Community Medicine, Assam Medical College, Dibrugarh, Assam, India
| | - Madhab Ch Rajbangshi
- Department of Surgery, Tezpur Medical College and Hospital, Tezpur, Assam, India
| | - Ranjumoni Konwar
- Department of Radiology, Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, Assam, India
| | - Bharati Basumatari
- Department of Radiology, Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, Assam, India
| |
Collapse
|
25
|
Hartley K, Ryan PH, Gillespie GL, Perazzo J, Wright JM, Rice GE, Donovan GH, Gernes R, Hershey GKK, LeMasters G, Brokamp C. Residential greenness, asthma, and lung function among children at high risk of allergic sensitization: a prospective cohort study. Environ Health 2022; 21:52. [PMID: 35549707 PMCID: PMC9097404 DOI: 10.1186/s12940-022-00864-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 05/05/2022] [Indexed: 05/10/2023]
Abstract
BACKGROUND While benefits of greenness to health have been reported, findings specific to child respiratory health are inconsistent. METHODS We utilized a prospective birth cohort followed from birth to age 7 years (n = 617). Residential surrounding greenness was quantified via Normalized Difference Vegetation Index (NDVI) within 200, 400, and 800 m distances from geocoded home addresses at birth, age 7 years, and across childhood. Respiratory health outcomes were assessed at age 7 years, including asthma and lung function [percent predicted forced expiratory volume in the first second (%FEV1), percent predicted forced vital capacity (%FVC), and percent predicted ratio of forced expiratory volume in the first second to forced vital capacity (%FEV1/FVC)]. We assessed associations using linear and logistic regression models adjusted for community deprivation, household income, and traffic-related air pollution. We tested for effect measure modification by atopic status. RESULTS We noted evidence of positive confounding as inverse associations were attenuated upon adjustment in the multivariable models. We found evidence of effect measure modification of NDVI and asthma within 400 m at age 7 years by atopic status (p = 0.04), whereby children sensitized to common allergens were more likely to develop asthma as exposure to greenness increased (OR = 1.3, 95% CI: 0.9, 2.0) versus children not sensitized to common allergens (OR = 0.8, 95% CI: 0.5, 1.2). We found consistently positive associations between NDVI and %FEV1 and %FVC which similarly evidenced positive confounding upon adjustment. In the adjusted regression models, NDVI at 7 years of age was associated with %FEV1 (200 m: β = 2.1, 95% CI: 0.1, 3.3; 400 m: β = 1.6, 95% CI: 0.3, 2.9) and %FVC (200 m: β = 1.8, 95% CI: 0.7, 3.0; 400 m: β = 1.6, 95% CI: 0.3, 2.8; 800 m: β = 1.5, 95% CI: 0.1, 2.8). Adjusted results for %FEV1/FVC were non-significant except exposure at birth in the 400 m buffer (β = 0.81, 95% CI: 0.1, 1.5). We found no evidence of effect measure modification of NDVI by atopic status for objective measures of lung function. CONCLUSION Sensitivity to allergens may modify the effect of greenness on risk for asthma in children but greenness is likely beneficial for concurrent lung function regardless of allergic status.
Collapse
Affiliation(s)
- Kim Hartley
- Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229 USA
- College of Nursing, University of Cincinnati, 3110 Vine St, Cincinnati, OH 45219 USA
| | - Patrick H. Ryan
- Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229 USA
- College of Medicine, University of Cincinnati, 3230 Eden Ave, Cincinnati, OH 45267 USA
| | - Gordon L. Gillespie
- College of Nursing, University of Cincinnati, 3110 Vine St, Cincinnati, OH 45219 USA
| | - Joseph Perazzo
- College of Nursing, University of Cincinnati, 3110 Vine St, Cincinnati, OH 45219 USA
| | - J. Michael Wright
- Toxic Effects Assessment Branch (Cincinnati), Chemical and Pollutant Assessment Division, Center for Public Health and Environmental Assessment (CPHEA), Office of Research and Development, U.S. Environmental Protection Agency, 26 West M.L. King Drive, Cincinnati, OH 45268 USA
| | - Glenn E. Rice
- Toxic Effects Assessment Branch (Cincinnati), Chemical and Pollutant Assessment Division, Center for Public Health and Environmental Assessment (CPHEA), Office of Research and Development, U.S. Environmental Protection Agency, 26 West M.L. King Drive, Cincinnati, OH 45268 USA
| | - Geoffrey H. Donovan
- USDA Forest Service, PNW Research Station, 1220 SW 3rd Ave, Portland, OR 97204 USA
| | - Rebecca Gernes
- Association of Schools and Programs of Public Health (ASPPH), Environmental Health Research Participant, 2014-2016, 1900 M St NW #710, DC 20036 Washington, USA
| | - Gurjit K. Khurana Hershey
- Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229 USA
- College of Medicine, University of Cincinnati, 3230 Eden Ave, Cincinnati, OH 45267 USA
| | - Grace LeMasters
- College of Medicine, University of Cincinnati, 3230 Eden Ave, Cincinnati, OH 45267 USA
| | - Cole Brokamp
- Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229 USA
- College of Medicine, University of Cincinnati, 3230 Eden Ave, Cincinnati, OH 45267 USA
| |
Collapse
|
26
|
Langer S, Klee B, Gottschick C, Mikolajczyk R. Birth cohort studies using symptom diaries for assessing respiratory diseases–a scoping review. PLoS One 2022; 17:e0263559. [PMID: 35143524 PMCID: PMC8830678 DOI: 10.1371/journal.pone.0263559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 01/21/2022] [Indexed: 11/18/2022] Open
Abstract
Background Respiratory infections are the most frequent health problem in childhood leading to morbidity and socioeconomic burden. Studying symptoms of respiratory infections in home based settings requires dedicated prospective cohort studies using diaries. However, no information is available on which birth cohort studies using symptom diary data. A review of birth cohort studies with available symptom diary data, follow-up data, and bio samples is needed to support research collaborations and create potential synergies. Methods We conducted a scoping review of birth cohort studies using diaries for the collection of respiratory symptoms. The scoping review was conducted in accordance with the PRISMA Extension. We searched the electronic databases PubMed, Embase, Web of science and CINAHL (last search November 2020) resulting in 5872 records (based on title and abstract screening) eligible for further screening. Results We examined 735 records as full text articles and finally included 57 according to predefined inclusion criteria. We identified 22 birth cohort studies that collect(ed) data on respiratory symptoms using a symptom diary starting at birth. Numbers of participants ranged from 129 to 8677. Eight studies collected symptom diary information only for the first year of life, nine for the first two years or less and six between three and six years. Most of the cohorts collected biosamples (n = 18) and information on environmental exposures (n = 19). Conclusion Information on respiratory symptoms with daily resolution was collected in several birth cohorts, often including related biosamples, and these data and samples can be used to study full spectrum of infections, particularly including those which did not require medical treatment.
Collapse
Affiliation(s)
- Susan Langer
- Institute for Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - Bianca Klee
- Institute for Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - Cornelia Gottschick
- Institute for Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther University Halle-Wittenberg, Halle, Germany
- * E-mail:
| | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther University Halle-Wittenberg, Halle, Germany
| |
Collapse
|
27
|
Abstract
Asthma is common in children and exacerbations are usually triggered by respiratory viruses. There was considerable concern about the impact of COVID-19 on children with asthma. It was expected that children with asthma would fare poorly during the pandemic. However, the reported effect of the COVID-19 pandemic on pediatric asthma including acute asthma admissions, does not appear to be significant, but this needs careful follow-up. The socioeconomic effects of the pandemic and reduced healthcare access could potentially impact on ongoing delivery of health care in chronic respiratory conditions including asthma, especially in resource-poor settings. Children with chronic asthma need to be treated as per internationally published guidelines with innovative models of disease monitoring and ongoing care during the pandemic. During the pandemic, children with acute asthma need to be managed carefully based on local guidelines and using strict infection control policies. The use of technology such as telehealth and various tools of asthma management including questionnaires and digital monitoring will play an important role in asthma management during the pandemic. Medical professionals, healthcare administrators, and governments should be sensitive to the evolving needs of the community and work closely to continue to provide services in a challenging yet unresolved pandemic.
Collapse
|
28
|
Kunøe A, Sevelsted A, Chawes BLK, Stokholm J, Krakauer M, Bønnelykke K, Bisgaard H. Height and bone mineral content after inhaled corticosteroid use in the first 6 years of life. Thorax 2022; 77:745-751. [PMID: 35046091 DOI: 10.1136/thoraxjnl-2020-216755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 12/17/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Infants and young children might be particularly susceptible to the potential side effects from inhaled corticosteroid (ICS) on height and bone mineral content (BMC), but this has rarely been studied in long-term prospective studies. METHODS Children from two Copenhagen Prospective Studies on Asthma in Childhood cohorts were included. ICS use was registered prospectively from birth to age 6 and the cumulative dose was calculated. Primary outcomes were height and BMC from dual-energy X-ray absorptiometry (DXA) scans at age 6. RESULTS At age 6, a total of 930 children (84%) from the cohorts had a valid height measurement and 792 (71%) had a DXA scan. 291 children (31%) received a cumulated ICS dose equivalent to or above 10 weeks of standard treatment before age 6. We found an inverse association between ICS use and height, -0.26 cm (95% CI: -0.45 to -0.07) per 1 year standard treatment from 0 to 6 years of age, p=0.006. This effect was mainly driven by children with ongoing treatment between age 5 and 6 years (-0.31 cm (95% CI: -0.52 to -0.1), p=0.004), while there was no significant association in children who stopped treatment at least 1 year before age 6 (-0.09 cm (95% CI: -0.46 to 0.28), p=0.64). There was no association between ICS use and BMC at age 6. CONCLUSIONS ICS use in early childhood was associated with reduced height at age 6 years but only in children with continued treatment in the sixth year of life.
Collapse
Affiliation(s)
- Asja Kunøe
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Astrid Sevelsted
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Bo L K Chawes
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Jakob Stokholm
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark.,Department of Pediatrics, Næstved Hospital, Næstved, Denmark
| | - Martin Krakauer
- Department of Clinical Physiology and Nuclear Medicine, Herlev and Gentofte Hospital, Gentofte, Denmark.,Department of Clinical Physiology and Nuclear Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Klaus Bønnelykke
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Hans Bisgaard
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| |
Collapse
|
29
|
Ganti P, Suman A, Chaudhary S, Sangha B, David L, Sekhsaria S. The effect of the socioeconomic status on the measurement of asthma control. Allergy Asthma Proc 2022; 43:e11-e16. [PMID: 34983718 DOI: 10.2500/aap.2022.43.210103] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background: The Asthma Control Test (ACT) is a commonly used scoring system for evaluation of asthma control in the pediatric and adult populations. Asthma control has been deemed poor in those economically disadvantaged. Objective: To study whether the ACT is affected by socioeconomic status (SES) as evaluated by the percentage of the federal poverty level and the education level. Methods: This was a cross-sectional study (N = 307), in which the patients were surveyed for demographics data and underwent ACT scoring, spirometry (forced expiratory volume in the first second of expiration) and fractional concentration of exhaled nitric oxide testing. Results: There was a positive correlation of improved mean score on the ACT (p < 0.001) with higher education status and higher federal poverty level status. Conclusion: SES plays a factor in the way patients perceived their asthma control, and therefore affected how they scored on the ACT.
Collapse
Affiliation(s)
- Preetam Ganti
- From the Department of Internal Medicine, Medstar Union Memorial Hospital, Baltimore, Maryland
| | - Annya Suman
- From the Department of Internal Medicine, Medstar Union Memorial Hospital, Baltimore, Maryland
| | - Shivani Chaudhary
- Department of Geriatrics, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii; and
| | - Brijit Sangha
- From the Department of Internal Medicine, Medstar Union Memorial Hospital, Baltimore, Maryland
| | - Larick David
- Department of Emergency Medicine, Louisiana State University, New Orleans, Louisiana; and
| | - Sudhir Sekhsaria
- From the Department of Internal Medicine, Medstar Union Memorial Hospital, Baltimore, Maryland
| |
Collapse
|
30
|
Shahunja KM, Sly PD, Begum T, Biswas T, Mamun A. Family, neighborhood and psychosocial environmental factors and their associations with asthma in Australia: a systematic review and Meta-analysis. J Asthma 2021; 59:2539-2552. [PMID: 34905415 DOI: 10.1080/02770903.2021.2018707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Various associations between different environmental exposures and asthma have been reported in different countries and populations. We aimed to investigate the associations between family, neighborhood and psychosocial environmental factors and asthma-symptoms in Australia by conducting a systematic review and meta-analysis. DATA SOURCES We analyzed the primary research studies conducted in Australia across multiple databases, including PubMed, EMBASE and Scopus, published between 2000 and 2020. STUDY SELECTIONS The reviews and analyses focused on the overall association of different environmental exposures with the exacerbation of asthma-symptoms or asthma-related hospital visits. Quality-effect meta-analysis was done to estimate the pooled odds ratio for different environmental exposures for asthma-symptoms. RESULTS Among the 4799 unique published articles found, 46 were included here for systematic review and 28 for meta-analysis. Our review found that psychosocial factors, including low socioeconomic condition, maternal depression, mental stress, ethnicity, and discrimination, are associated with asthma-symptoms. Pooled analysis was conducted on family and neighborhood environmental factors and revealed that environmental tobacco smoking (ETS) (OR 1·69, 95% CI 1·19-2·38), synthetic bedding (OR 1·91, 95% CI 1·48-2·47) and gas heaters (OR 1·40, 95% CI 1·12-1·76) had significant overall associations with asthma-symptoms in Australia. CONCLUSION Although the studies were heterogeneous, both systematic review and meta-analysis found several psychosocial and family environmental exposures significantly associated with asthma-symptoms. Further study to identify their causal relationship and modification may reduce asthma-symptoms in the Australian population.
Collapse
Affiliation(s)
- K M Shahunja
- Institute for Social Science Research, The University of Queensland, Brisbane, Australia.,ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Australia.,The Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Brisbane, Australia
| | - Peter D Sly
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Tahmina Begum
- Institute for Social Science Research, The University of Queensland, Brisbane, Australia.,ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Australia
| | - Tuhin Biswas
- Institute for Social Science Research, The University of Queensland, Brisbane, Australia.,ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Australia
| | - Abdullah Mamun
- Institute for Social Science Research, The University of Queensland, Brisbane, Australia.,ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Australia.,The Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Brisbane, Australia
| |
Collapse
|
31
|
De La Cruz N, Hines JH, Shaw C, Appiah D. Geographic Disparity in Asthma Hospitalizations: The Role of Race/Ethnicity, Socioeconomic Status, and Other Factors. Cureus 2021; 13:e20015. [PMID: 34873552 PMCID: PMC8631481 DOI: 10.7759/cureus.20015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 11/05/2022] Open
Abstract
Background In the United States, asthma is the most common chronic disease in children, and is associated with low sociodemographic, economic, and environmental factors. Objective To investigate geographic disparities in asthma hospitalizations and the roles that race/ethnicity, health insurance, and other environmental factors played on these disparities in Lubbock County, Texas. Methods Data were obtained from the Texas Inpatient Public Use Data File for the years 1999-2018. International classification of disease codes were used to identify primary diagnoses of asthma among all severe inpatient admissions. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results Of the 248,768 patients admitted for severe conditions, 4,224 had a primary diagnosis of asthma. In multivariable-adjusted models, the odds of asthma hospitalizations varied across geographic regions of Lubbock with the Northeast having the highest age-adjusted prevalence (7.17 per 1,000) and ORs for asthma hospitalizations (OR: 1.25, CI: 1.12-1.40). Data suggested that non-Hispanic Blacks using federal insurance in the Northeast region had the highest odds for asthma hospitalizations (OR: 4.88, CI: 3.06-7.79; p-interaction = 0.001). Across all regions, a 1 μg/m3 increase in particulate matter 2.5 was associated with a 27% higher likelihood of asthma hospitalization (OR: 1.27, 95% CI: 1.23-1.31). Conclusion In this study, geographic disparities in asthma hospitalizations were observed within Lubbock County and were significantly influenced by a disparate distribution of socioeconomic factors related to health insurance and race/ethnicity. The potential contributory role of particulate matter needs further investigation.
Collapse
Affiliation(s)
- Noah De La Cruz
- College of Osteopathic Medicine, Sam Houston State University, Conroe, USA
| | - Jonathon H Hines
- College of Osteopathic Medicine, Sam Houston State University, Conroe, USA
| | - Chip Shaw
- Public Health, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Duke Appiah
- Public Health, Texas Tech University Health Sciences Center, Lubbock, USA
| |
Collapse
|
32
|
Lawrence KG, Werder EJ, Sandler DP. Association of neighborhood deprivation with pulmonary function measures among participants in the Gulf Long-Term Follow-up Study. ENVIRONMENTAL RESEARCH 2021; 202:111704. [PMID: 34280418 PMCID: PMC8578346 DOI: 10.1016/j.envres.2021.111704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Individual-level socioeconomic status (SES) has been shown to be an important determinant of lung function. Neighborhood level SES factors may increase psychological and physiologic stress and may also reflect other exposures that can adversely affect lung function, but few studies have considered neighborhood factors. OBJECTIVE Our aim was to assess the association between neighborhood-level SES and lung function. METHODS We cross-sectionally analyzed 6168 spirometry test results from participants in the Gulf long-term Follow-up Study, a large cohort of adults enrolled following the largest maritime oil spill in US history. Outcomes of interest included the forced expiratory volume in 1 s (FEV1; mL), the forced vital capacity (FVC; mL), and the FEV1/FVC ratio (%). Neighborhood deprivation was measured by linking participant home addresses to an existing Area Deprivation Index (ADI) and categorized into quartiles. Individual-level SES measures were collected at enrollment using a structured questionnaire and included income, educational attainment, and financial strain. We used multilevel regression to estimate associations between ADI quartiles and each lung function measure. RESULTS Greater neighborhood deprivation was associated with lower FEV1: βQ2vsQ1: -30 mL (95% CI: -97, 36), βQ3vsQ1: -70 mL (95% CI: -135, -4) and βQ4vsQ1: -104 mL (95% CI: -171, -36). FVC showed similar patterns of associations with neighborhood deprivation. No associations with the FEV1/FVC ratio were observed. CONCLUSION Neighborhood deprivation, a measure incorporating economic and other stressors, was associated with lower FEV1 and FVC, with magnitudes of associations reaching clinically meaningful levels. The impact of this neighborhood SES measure persisted even after adjustment for individual-level SES factors.
Collapse
Affiliation(s)
- Kaitlyn G Lawrence
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC, USA
| | - Emily J Werder
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC, USA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC, USA.
| |
Collapse
|
33
|
Caffrey Osvald E, Gong T, Lundholm C, Larsson H, Bk B, Almqvist C. Parental socioeconomic status and asthma in children: Using a population-based cohort and family design. Clin Exp Allergy 2021; 52:94-103. [PMID: 34676942 DOI: 10.1111/cea.14037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/24/2021] [Accepted: 10/14/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND The observed association between the parental socioeconomic status (SES, measured as education/income) and asthma or wheezing in offspring may be explained by confounding of unmeasured factors (shared genes and family environment). We aimed to study the association between parental SES and asthma/wheeze using cousin comparison. METHOD Data were collected on individuals born in Sweden 2001-2013. Parental SES (education and income) was gathered from Statistics Sweden. Asthma/wheeze was identified using national health registers. The association between parental SES at birth and incident asthma/wheeze was estimated using Cox regression also comparing differently exposed cousins. The association between parental SES at 5 years and current asthma was estimated using logistic regression. RESULTS Included were 955,371 individuals. Mothers with compulsory school only (lowest education group) compared with those with further education (highest education group) was associated with incident asthma/wheeze below 1 year of age HRadj = 1.45 (1.38-1.52) and over 1 year of age HRadj = 1.17 (1.13-1.20). The corresponding estimates for the lowest income group were HRadj = 1.61 (1.54-1.69) and HRadj = 0.94 (0.92-0.97), respectively. In maternal cousin comparisons, the associations for asthma/wheeze over 1 year of age was HRadj = 1.21 (1.05-1.40) for compulsory school only and HRadj = 0.94 (0.84-1.07) for the lowest income group. The ORadj for current asthma at 5 years was 1.05 (1.00-1.11) for mother's compulsory school only and 0.98 (0.94-1.02) for mother's lowest income group. Results for estimates were similar for father's SES. CONCLUSION We confirm an association between low parental SES (measured as education) and asthma/wheeze. Cousin comparison suggests that this association is not wholly due to confounding of unknown familial factors, therefore supporting a causal relationship. The relationship between parental income and asthma/wheeze is less clear. This study is important for understanding risk factors for asthma/wheeze and for future prevention strategies. Further research is warranted to investigate the possible mechanisms for association between parental education and asthma/wheeze.
Collapse
Affiliation(s)
- Emma Caffrey Osvald
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Tong Gong
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Lundholm
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,School of Medical Sciences, Campus USÖ, Örebro, Sweden
| | - Brew Bk
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Centre for Big Data Research in Health and School of Women's and Children's Health, AGSM Building, University of New South Wales, Kensington, NSW, Australia
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
34
|
Associations of Exposure to Nitrogen Oxides with Prevalent Asthma and Other Atopic Diseases in Israel. ENVIRONMENTS 2021. [DOI: 10.3390/environments8100110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Childhood exposure to nitrogen oxides (NOx) is considered a risk factor for the onset of asthma. However, associations of this exposure with other atopic diseases and factors that modify this association are less clear. We aimed to study associations between exposure to NOx and the prevalence of atopic diseases in Israeli adolescents using a cross-sectional design. The study population comprised all Israeli-born adolescents whose medical status was evaluated for mandatory military recruitment during 1967–2017 (n = 2,523,745), of whom 5.9% had prevalent asthma. We based the exposure assessments on a land-use regression model and estimated associations using multivariable logistic regression models. Across all periods, mean exposure to NOx from birth to adolescence was associated with prevalent asthma at the examination in a dose-response manner, with an odds ratio for the upper quintile of 1.61 (95% CI: 1.56–1.67), in comparison to the lowest quintile. Associations were stronger in males and in lower socioeconomic strata. We found the strongest associations for asthma with comorbid rhinitis, with an almost twofold increase in the odds of upper versus lower quintile of exposure (odds ratio = 1.96, 95% CI: 1.82–2.11). Rhino-conjunctivitis and allergic atopic dermatitis suggested a possible threshold level with NOx. Capsule Summary: Research indicates that half of the global population will suffer from an allergic condition at some point in life. Childhood exposure to nitrogen oxides is a risk factor for the onset of asthma. The association between exposure and allergic diseases other than asthma is unclear. We demonstrate a strong, dose-response relationship between exposure and a group of allergic outcomes, using data comprising 2.5 million subjects over 50 years. The large health benefits from clean air should motivate governments to prioritize mitigation measures.
Collapse
|
35
|
Li Y, Chen W, Tian S, Xia S, Yang B. Evaluating the Causal Association Between Educational Attainment and Asthma Using a Mendelian Randomization Design. Front Genet 2021; 12:716364. [PMID: 34434223 PMCID: PMC8381375 DOI: 10.3389/fgene.2021.716364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/12/2021] [Indexed: 12/12/2022] Open
Abstract
Asthma is a common chronic respiratory disease. In the past 10 years, genome-wide association study (GWAS) has been widely used to identify the common asthma genetic variants. Importantly, these publicly available asthma GWAS datasets provide important data support to investigate the causal association of kinds of risk factors with asthma by a Mendelian randomization (MR) design. It is known that socioeconomic status is associated with asthma. However, it remains unclear about the causal association between socioeconomic status and asthma. Here, we selected 162 independent educational attainment genetic variants as the potential instruments to evaluate the causal association between educational attainment and asthma using large-scale GWAS datasets of educational attainment (n = 405,072) and asthma (n = 30,810). We conducted a pleiotropy analysis using the MR-Egger intercept test and the MR pleiotropy residual sum and outlier (MR-PRESSO) test. We performed an MR analysis using inverse-variance weighted, weighted median, MR-Egger, and MR-PRESSO. The main analysis method inverse-variance weighted indicated that each 1 standard deviation increase in educational attainment (3.6 years) could reduce 35% asthma risk [odds ratio (OR) = 0.65, 95% confidence interval (CI) 0.51–0.85, P = 0.001]. Importantly, evidence from other MR methods further supported this finding, including weighted median (OR = 0.55, 95% CI 0.38–0.80, P = 0.001), MR-Egger (OR = 0.48, 95% CI 0.16–1.46, P = 0.198), and MR-PRESSO (OR = 0.65, 95% CI 0.51–0.85, P = 0.0015). Meanwhile, we provide evidence to support that educational attainment protects against asthma risk dependently on cognitive performance using multivariable MR analysis. In summary, we highlight the protective role of educational attainment against asthma. Our findings may have public health applications and deserve further investigation.
Collapse
Affiliation(s)
- Yunxia Li
- Department of Respiratory and Critical Care Medicine, Affiliated Central Hospital, Shenyang Medical College, Shenyang, China
| | - Wenhao Chen
- Department of Respiratory and Critical Care Medicine, Affiliated Central Hospital, Shenyang Medical College, Shenyang, China
| | - Shiyao Tian
- Department of Respiratory and Critical Care Medicine, Affiliated Central Hospital, Shenyang Medical College, Shenyang, China
| | - Shuyue Xia
- Department of Respiratory and Critical Care Medicine, Affiliated Central Hospital, Shenyang Medical College, Shenyang, China
| | - Biao Yang
- Department of Pathogen Biology, Shenyang Medical College, Shenyang, China
| |
Collapse
|
36
|
Needham BL, Straight B, Hilton CE, Olungah CO, Lin J. Family socioeconomic status and child telomere length among the Samburu of Kenya. Soc Sci Med 2021; 283:114182. [PMID: 34225037 DOI: 10.1016/j.socscimed.2021.114182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/27/2021] [Accepted: 06/25/2021] [Indexed: 01/08/2023]
Abstract
Previous research in high-income countries suggests that children from families with lower socioeconomic status (SES) tend to have shorter telomere length - a biomarker of stress and cell aging - than children from families with greater social and economic resources. However, little is known about predictors of child telomere length in low-income settings. Data for the current study are from a sample of 214 Samburu children aged 1-9 years. The Samburu are semi-nomadic pastoralists who live in the Rift Valley of north-central Kenya. Samburu livelihood is based primarily on livestock, and polygynous marriage is common. Drawing on prior ethnographic research, we measured 14 culturally relevant indicators of family SES, including mother's education, head of household's education, whether the child is currently attending school, household spending, mother's employment history, head of household's employment history, mother's perceived wealth, whether the child lives in a modern house, livestock holdings (total, cows, sheep/goats, and camels), mother's wife number, and whether the child lives in a polygynous household. Telomere length was measured in salivary DNA by the quantitative polymerase chain reaction (qPCR) method. Using latent class analysis, we identified four groups of children that are similar based on the 14 indicators of family SES: Lower SES; Middle SES, Traditional; Middle SES, Modern; and Higher SES. SES classes were not significantly associated with child telomere length. In models examining individual indicators of SES, we found that telomere length was 0.57 standard deviations greater for children who lived in families in the lowest quartile of total livestock holdings compared to those in the highest quartile (b = 0.57, p = 0.03). While additional research is needed to identify the mechanisms underlying this counterintuitive finding, the current study highlights the importance of cultural context in shaping the social gradient in health.
Collapse
Affiliation(s)
- Belinda L Needham
- Department of Epidemiology and Center for Social Epidemiology and Population Health, University of Michigan, USA.
| | - Bilinda Straight
- Department of Gender and Women's Studies, Western Michigan University, USA
| | - Charles E Hilton
- Department of Anthropology, University of North Carolina, Chapel Hill, USA
| | | | - Jue Lin
- Department of Biochemistry and Biophysics, University of California, San Francisco, USA
| |
Collapse
|
37
|
Parental Education and the Association between Fruit and Vegetable Consumption and Asthma in Adolescents: The Greek Global Asthma Network (GAN) Study. CHILDREN-BASEL 2021; 8:children8040304. [PMID: 33923381 PMCID: PMC8071508 DOI: 10.3390/children8040304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/11/2021] [Accepted: 04/13/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Evidence suggests that nutritional factors, such as consumption of fruits and vegetables, along with socioeconomic factors such as parental education level, are associated with asthma prevalence. Our study examined the role of parental education in the association between fruit and vegetable consumption and adolescent asthma. METHODS 1934 adolescents (mean age: 12.7 years, standard deviation: 0.6 years, boys: 47.5%) and their parents were voluntarily enrolled and completed a validated questionnaire assessing current asthma status, fruit and vegetable consumption and parental educational level. Participants were categorized as high or low intake for five food groups: fruits, cooked vegetables, raw vegetables, all vegetables (cooked and raw), and all three food groups together (fruits and all vegetables). RESULTS Adolescents who were high consumers of all three food groups (fruits, cooked and raw vegetables) were less likely to have asthma, adjusted for several confounders (adjusted odds ratio (aOR): 0.53, 95% confidence interval (CI): 0.25-0.97). Moreover, in adolescents who had parents with tertiary education and were in the high consumption of all three food groups, the inverse association was almost twofold higher than the one for adolescents with parents of primary/secondary education (aOR: 0.35, 95% CI: (0.21-0.89) and aOR: 0.61, 95% CI: (0.47-0.93) respectively). CONCLUSIONS Our findings highlight the importance of the adoption of a diet rich in fruits and vegetables for all asthmatic adolescents and emphasize the important role of parental influences in this association.
Collapse
|
38
|
Yang-Huang J, van Grieken A, You Y, Jaddoe VWV, Steegers EA, Duijts L, Boelens M, Jansen W, Raat H. Changes in Family Poverty Status and Child Health. Pediatrics 2021; 147:peds.2020-016717. [PMID: 33685984 DOI: 10.1542/peds.2020-016717] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/30/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES In this study, we aim to assess the associations over time between poverty and child weight status, asthma, and health-related quality of life (HRQoL). METHODS We analyzed data for 3968 children from the Generation R Study, a population-based cohort study in the Netherlands. Net household income and the number of adults and children living from this income were measured at 4 time-points (during pregnancy and at ages 2, 3, and 6). Poverty was defined on the basis of the equivalized household income being <60% of the median national income. Child health outcomes were measured at age 6 years. The association was explored by using logistic and linear regression models. RESULTS In this cohort, 9.8% of children were born into poverty and 6.0% had experienced 3 to 4 episodes of poverty. Independent of current poverty status, children born into poverty had an odds ratio (OR) of 1.68 for having overweight/obesity and a lower physical HRQoL (OR = -1.32) than those not born into poverty. Children having experienced 3 to 4 episodes of poverty had an OR of 1.94 for having asthma and a lower physical HRQoL (OR = -3.32) compared with children from never-poor families. Transition out of poverty before age 2 was associated with lower risk of asthma and a higher physical HRQoL compared with children who remained in poverty. CONCLUSIONS Being born into poverty or experiencing multiple episodes of poverty is associated with negative child health outcomes, such as having overweight, asthma, or a lower HRQoL. Support for children and families with a low household income is warranted.
Collapse
Affiliation(s)
| | | | - Yueyue You
- The Generation R Study Group.,Public Health, and
| | - Vincent W V Jaddoe
- The Generation R Study Group.,Departments of Pediatrics.,Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Eric A Steegers
- Obstetrics and Gynecology, Erasmus Medical Center, University Medical Centre Rotterdam, Rotterdam, the Netherlands; and
| | - Liesbeth Duijts
- Divisions of Respiratory Medicine and Allergology and Neonatology, Departments of Pediatrics and
| | | | - Wilma Jansen
- Public Health, and.,Municipality of Rotterdam, Rotterdam, the Netherlands
| | | |
Collapse
|
39
|
Jassal MS, Lewis-Land C, Thompson RE, Butz A. Randomised pilot trial of cash incentives for reducing paediatric asthmatic tobacco smoke exposures from maternal caregivers and members of their social network. Arch Dis Child 2021; 106:345-354. [PMID: 33004310 PMCID: PMC7982931 DOI: 10.1136/archdischild-2019-318352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 08/22/2020] [Accepted: 08/28/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The primary aim was to evaluate the efficacy of financial incentives for reducing paediatric tobacco smoke exposures (TSEs) through motivating cigarette usage reduction among low-income maternal caregivers and members of their social network. DESIGN Randomised control pilot trial over a 6-month study follow-up time period. The study was undertaken from May 2017 to -May 2018. Once monthly follow-up visits occurred over the 6-month study period. SETTING Baltimore City, Maryland, USA. PARTICIPANTS We grouped 135 participants into 45 triads (asthmatic child (2-12 years of age), maternal caregiver and social network member). Triads were assigned in a 1:1 allocation ratio. The maternal caregiver and social network members were active smokers and contributed to paediatric TSE. INTERVENTIONS Triads were randomised to receive either usual care (TSE education and quitline referrals) or usual care plus financial incentives. Cash incentives up to $1000 were earned by caregivers and designated social network participants. Incentives for either caregivers or social network participants were provided contingent on their individual reduction of tobacco usage measured by biomarkers of tobacco usage. Study visits occurred once a month during the 6-month trial. MAIN OUTCOME MEASURES The main outcome measure was mean change in monthly paediatric cotinine levels over 6 months of follow-up interval and was analysed on an intention-to-treat basis. RESULTS The mean change in monthly child cotinine values was not significantly different in the intervention cohort over the 6-month follow-up period, compared with the control group (p=0.098, CI -0.16 to 1.89). Trends in child cotinine could not be ascribed to caregivers or social network members. Despite decreasing mean monthly cotinine values, neither the intervention cohort's caregivers (difference in slope (control-intervention)=3.30 ng/mL/month, CI -7.72 to 1.13, p=0.144) or paired social network members (difference in slope (control-intervention)=-1.59 ng/mL/month, CI -3.57 to 6.74, p=0.546) had significantly different cotinine levels than counterparts in the control group. CONCLUSIONS Financial incentives directed at adult contributors to paediatric TSE did not decrease child cotinine levels. TRIAL REGISTRATION NUMBER NCT03099811.
Collapse
Affiliation(s)
- Mandeep S Jassal
- Department of Pediatrics, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Cassia Lewis-Land
- Department of Pediatrics, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Richard E Thompson
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Arlene Butz
- Department of Pediatrics, Johns Hopkins Medicine, Baltimore, Maryland, USA
| |
Collapse
|
40
|
Levesque AR, MacDonald S, Berg SA, Reka R. Assessing the Impact of Changes in Household Socioeconomic Status on the Health of Children and Adolescents: A Systematic Review. ADOLESCENT RESEARCH REVIEW 2021; 6:91-123. [PMID: 33553578 PMCID: PMC7853168 DOI: 10.1007/s40894-021-00151-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/15/2021] [Indexed: 06/12/2023]
Abstract
UNLABELLED Understanding how child and adolescent health is influenced by fluctuations in socioeconomic status has important public health and policy implications, as children are often subjected to both micro and macro-level socioeconomic events. This study provides the first systematic review to date on the relationship between changes in household or parental socioeconomic status and subsequent child and adolescent health outcomes. Eighty articles were identified for inclusion in this review, examining 85 different socioeconomic exposures in five categories: Income (n = 64), Employment (n = 14), Socioeconomic Mobility (n = 3), Education (n = 2), and Food Insecurity (n = 2). The health outcomes analyzed by these eighty articles were separated into eight discrete categories, with many articles examining outcomes in more than one category: Anthropometric Measurements (n = 21), Cognition and Development (n = 15), Dental Health (n = 3), Health Behaviours (n = 9), Mental Health (n = 12), Overall Parent/Guardian Assessed health (n = 6); Physical Health Outcomes (n = 11), and Socio-Emotional Behaviour (n = 30). Several consistent patterns emerged in the literature, such as a link between increased income and improved, or decreased income and deteriorating, cognition, dental health, and physical health. The results of this review suggest a need to replicate current studies in diverse geographies to expand generalizability and clarify regional patterns. There should also be an effort to go beyond income, and employment, to assess the relationship between less frequently studied socioeconomic exposures and child health outcomes. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40894-021-00151-8.
Collapse
Affiliation(s)
| | - Sarah MacDonald
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON Canada
| | - Selinda Adelle Berg
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON Canada
- Leddy Library, University of Windsor, Windsor, ON Canada
| | - Roger Reka
- Leddy Library, University of Windsor, Windsor, ON Canada
| |
Collapse
|
41
|
Alsallakh MA, Rodgers SE, Lyons RA, Sheikh A, Davies GA. Association of socioeconomic deprivation with asthma care, outcomes, and deaths in Wales: A 5-year national linked primary and secondary care cohort study. PLoS Med 2021; 18:e1003497. [PMID: 33577558 PMCID: PMC7880491 DOI: 10.1371/journal.pmed.1003497] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 01/15/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Socioeconomic deprivation is known to be associated with worse outcomes in asthma, but there is a lack of population-based evidence of its impact across all stages of patient care. We investigated the association of socioeconomic deprivation with asthma-related care and outcomes across primary and secondary care and with asthma-related death in Wales. METHODS AND FINDINGS We constructed a national cohort, identified from 76% (2.4 million) of the Welsh population, of continuously treated asthma patients between 2013 and 2017 using anonymised, person-level, linked, routinely collected primary and secondary care data in the Secure Anonymised Information Linkage (SAIL) Databank. We investigated the association between asthma-related health service utilisation, prescribing, and deaths with the 2011 Welsh Index of Multiple Deprivation (WIMD) and its domains. We studied 106,926 patients (534,630 person-years), 56.3% were female, with mean age of 47.5 years (SD = 20.3). Compared to the least deprived patients, the most deprived patients had slightly fewer total asthma-related primary care consultations per patient (incidence rate ratio [IRR] = 0.98, 95% CI 0.97-0.99, p-value < 0.001), slightly fewer routine asthma reviews (IRR = 0.98, 0.97-0.99, p-value < 0.001), lower controller-to-total asthma medication ratios (AMRs; 0.50 versus 0.56, p-value < 0.001), more asthma-related accident and emergency (A&E) attendances (IRR = 1.27, 1.10-1.46, p-value = 0.001), more asthma emergency admissions (IRR = 1.56, 1.39-1.76, p-value < 0.001), longer asthma-related hospital stay (IRR = 1.64, 1.39-1.94, p-value < 0.001), and were at higher risk of asthma-related death (risk ratio of deaths with any mention of asthma 1.56, 1.18-2.07, p-value = 0.002). Study limitations include the deprivation index being area based and the potential for residual confounders and mediators. CONCLUSIONS In this study, we observed that the most deprived asthma patients in Wales had different prescribing patterns, more A&E attendances, more emergency hospital admissions, and substantially higher risk of death. Interventions specifically designed to improve treatment and outcomes for these disadvantaged groups are urgently needed.
Collapse
Affiliation(s)
- Mohammad A. Alsallakh
- Swansea University Medical School, Swansea, United Kingdom
- Health Data Research UK, Swansea and Edinburgh, United Kingdom
- Asthma UK Centre for Applied Research, Edinburgh, United Kingdom
| | - Sarah E. Rodgers
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
| | - Ronan A. Lyons
- Swansea University Medical School, Swansea, United Kingdom
- Health Data Research UK, Swansea and Edinburgh, United Kingdom
| | - Aziz Sheikh
- Health Data Research UK, Swansea and Edinburgh, United Kingdom
- Asthma UK Centre for Applied Research, Edinburgh, United Kingdom
- Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Gwyneth A. Davies
- Swansea University Medical School, Swansea, United Kingdom
- Asthma UK Centre for Applied Research, Edinburgh, United Kingdom
| |
Collapse
|
42
|
Cavaleiro Rufo J, Paciência I, Hoffimann E, Moreira A, Barros H, Ribeiro AI. The neighbourhood natural environment is associated with asthma in children: A birth cohort study. Allergy 2021; 76:348-358. [PMID: 32654186 DOI: 10.1111/all.14493] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/04/2020] [Accepted: 06/10/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND A lower exposure to the natural environment has been hypothesized to adversely affect the human microbiome and its immunomodulatory capacity. However, the underlying effects of this hypothesis are still not understood. We aimed to evaluate the effect of early-life exposure to greenness and species richness on the development of allergic diseases and asthma in children. METHODS A longitudinal study was conducted comprising 1050 children from a population-based birth cohort recruited in Portugal. Residential normalized difference vegetation index (NDVI) and species richness index (SRI) were assessed at baseline to estimate their association with allergic diseases and asthma at the ages of 4 and 7. RESULTS Significant predisposing associations were observed between the exposure to species richness at baseline and the onset of asthma and wheezing at the age of 7. Children living in neighbourhoods surrounded by high levels of SRI were at a significantly higher risk developing allergic sensitization(OR [95% CI] = 2.00 [1.04:3.86] at age 4; 2.35 [1.20:4.63] at age 7). Living surrounded by greener environments was significantly associated with a lower prevalence of asthma and rhinitis at the age of 7(0.41 [0.18:0.97] and 0.37 [0.15:0.93], respectively). CONCLUSIONS Living in close proximity to a greener environment at birth has a protective effect on the development of allergic diseases and asthma at the age of 7. Conversely, living in neighbourhoods with a high number of fauna species appears to be associated with a higher risk for allergy, asthma and wheezing.
Collapse
Affiliation(s)
- João Cavaleiro Rufo
- EPIUnit Instituto de Saúde Pública da Universidade do Porto Porto Portugal
- Faculdade de Medicina da Universidade do Porto Porto Portugal
| | - Inês Paciência
- EPIUnit Instituto de Saúde Pública da Universidade do Porto Porto Portugal
- Faculdade de Medicina da Universidade do Porto Porto Portugal
| | - Elaine Hoffimann
- EPIUnit Instituto de Saúde Pública da Universidade do Porto Porto Portugal
| | - André Moreira
- EPIUnit Instituto de Saúde Pública da Universidade do Porto Porto Portugal
- Faculdade de Medicina da Universidade do Porto Porto Portugal
| | - Henrique Barros
- EPIUnit Instituto de Saúde Pública da Universidade do Porto Porto Portugal
- Faculdade de Medicina da Universidade do Porto Porto Portugal
| | - Ana Isabel Ribeiro
- EPIUnit Instituto de Saúde Pública da Universidade do Porto Porto Portugal
- Faculdade de Medicina da Universidade do Porto Porto Portugal
| |
Collapse
|
43
|
Lau N, Smith MJ, Sarkar A, Gao Z. Effects of low exposure to traffic related air pollution on childhood asthma onset by age 10 years. ENVIRONMENTAL RESEARCH 2020; 191:110174. [PMID: 32919973 DOI: 10.1016/j.envres.2020.110174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/11/2020] [Accepted: 09/03/2020] [Indexed: 06/11/2023]
Abstract
Although NO2, a major traffic related air pollutant, has been associated with onset of childhood asthma, young children may be more susceptible to traffic related air pollution exposure compared to other individuals. We linked data from National Longitudinal Survey of Children and Youths Cycle 1-5 (1994-2003) and the National Air Pollution Surveillance Program to determine the association between NO2 exposure and either early or late onset childhood asthma phenotypes. Children diagnosed with asthma from age 0-3 were defined as having early onset asthma. Children diagnosed with asthma from age 4-9 were defined as having late onset asthma. Mean NO2 exposure for each quartile was 6.31 ppb, 9.45 ppb, 11.83 ppb, and 17.9 ppb. Higher levels of NO2 exposure were more strongly associated with early childhood asthma (Quartile 3 OR: 2.11, 95% CI: 1.29, 3.44, Quartile 4 OR: 2.16, 95% CI: 1.27, 3.68) compared to the lowest level of NO2 exposure (Quartile 1). No such association was observed with risk of late childhood asthma onset. Asthma susceptibility to NO2 exposure may vary with the childhood developmental stage, and young children may be susceptible to NO2 exposure at levels well below national and international guidelines. Our study emphasizes the importance of considering the timing of childhood asthma onset in future studies and confirms the increased risk of early onset of childhood asthma associated even with relatively low NO2 exposure levels.
Collapse
Affiliation(s)
- Nelson Lau
- Clinical Epidemiology Unit, Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, A1B 3V6, Canada
| | - Mary Jane Smith
- Discipline of Pediatrics, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, A1B 3V6, Canada
| | - Atanu Sarkar
- Clinical Epidemiology Unit, Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, A1B 3V6, Canada
| | - Zhiwei Gao
- Clinical Epidemiology Unit, Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, A1B 3V6, Canada.
| |
Collapse
|
44
|
Korsten K, Naaktgeboren CA, Bont LJ, van der Ent CK, de Hoog MLA. Defining asthma in children: how well do parents, doctors and spirometry agree? ERJ Open Res 2020; 6:00348-2019. [PMID: 33043055 PMCID: PMC7533381 DOI: 10.1183/23120541.00348-2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 06/26/2020] [Indexed: 11/12/2022] Open
Abstract
Background Because diagnosing asthma in school-aged children is challenging, a variety of proxies for asthma are used in clinical practice and research settings as indicators of this disease. We aimed to provide insight into the agreement between various asthma indicators based on parental report, medical diagnosis and spirometry. Methods Children from the WHISTLER birth cohort performed spirometry and were followed up with parental ISAAC (International Study of Asthma and Allergies in Childhood) questionnaires about asthma at 5 and 8 years of age. Medical data were extracted from primary care records. We compared 15 asthma indicators based on parental report, medical diagnosis and spirometry using positive agreement, κ statistics and latent class cluster analysis. Results At 5 years of age, 1007 children completed a study visit, while 803 children visited at 8 years of age. Depending on the indicator, the responder and child's age, the asthma prevalence ranged from 0.2% to 26.6%. Cluster analysis revealed classes related to the presence of recent symptoms and a decreased lung function. Agreement between parents and doctors was generally low with κ coefficients ranging from 0.07 (recent wheeze) to 0.52 (recent asthma medication). Additionally, parental report showed to be sensitive to recall bias over time. Conclusions Dependent on the asthma indicator, the responder and the age of the child, substantial differences in agreement were observed between commonly used indicators associated with asthmatic disease in school-aged children. Most agreement between parents and doctors was seen for objective and recent indicators such as the recent use of asthma medication. We advocate caution when literature with different asthma indicators is compared. A variety of clinical definitions are used as indicators of asthma. There are substantial differences in agreement between parents, doctors and lung function. Caution is needed when literature with different asthma indicators is compared.https://bit.ly/2VxDH8p
Collapse
Affiliation(s)
- Koos Korsten
- Dept of Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Christiana A Naaktgeboren
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Louis J Bont
- Dept of Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Cornelis K van der Ent
- Dept of Paediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Marieke L A de Hoog
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| |
Collapse
|
45
|
Khreis H, Alotaibi R, Horney J, McConnell R. The impact of baseline incidence rates on burden of disease assessment of air pollution and onset childhood asthma: analysis of data from the contiguous United States. Ann Epidemiol 2020; 53:76-88.e10. [PMID: 32956840 DOI: 10.1016/j.annepidem.2020.08.063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 08/11/2020] [Accepted: 08/27/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE Burden of disease (BoD) assessments typically rely on national-level incidence rates for the health outcomes of interest. The impact of using a constant national-level incidence rate, versus a more granular spatially varying rate, remains unknown and understudied in the literature. There has been an increasing number of publications estimating the BoD of childhood asthma attributable to air pollution, as emerging evidence demonstrates that traffic-related air pollution (TRAP) leads to onset of the disease. In this study, we estimated the burden of incident childhood asthma cases which may be attributable to nitrogen dioxide (NO2), a criteria pollutant and a good marker of TRAP, in the contiguous United States. We used both a national-level and newly generated state-specific asthma incidence rates and compared results from the two approaches. METHODS We estimated incident childhood asthma cases which may be attributable to NO2 using standard BoD assessment methods. We combined child (<18 years) counts with 2010 NO2 exposures at the census block level, concentration-response function, and state-specific asthma incidence rates. NO2 concentrations were obtained from a previously validated land-use regression model. We sourced the concentration-response function from a meta-analysis on TRAP and risk of childhood asthma. We estimated incidence rates using raw data collected in the 2006-2010 Behavioral Risk Factor Surveillance System and Asthma Call-back Surveys. We stratified the estimated BoD by urban versus rural status and by median household income, explored trends in BoD across 48 states and the District of Columbia, and compared our results with a published BoD analysis which used a constant national-level incidence rate across all states. RESULTS The overall mean (min-max) NO2 concentration(s) was 13.2 (1.5-58.3) ug/m3 and was highest in urbanized areas. The estimated national aggregate asthma incidence rate was 11.6 per 1000 at-risk children and ranged from 4.3 (Montana) to 17.7 (District of Columbia) per 1000 at-risk children. The 17 states that did not have data to estimate an incidence rate were assigned the national aggregate asthma incidence rate. Using the state-specific incidence rates, we estimated a total of 134,166 (95% confidence interval: 75,177-193,327) childhood asthma incident cases attributable to NO2, accounting for 17.6% of all childhood asthma incident cases. Using the national-level incidence rate, we estimated a total of 141,931 (95% confidence interval: 119,222-163,505) incident cases attributable to NO2, accounting for 17.9% of all childhood asthma incident cases. Using the state-specific incidence rates therefore reduced the attributable number of cases by 7,765 (5.5% relative reduction), compared with estimates using the national-level incidence rate. Across states, the change in the attributable number of cases ranged from -64.1% (Montana) to +33.8% (Texas). California had the largest absolute decrease (-6,190) in attributable cases, whereas Texas had the largest increase (+3,615). Stratifying by socioeconomic status and urban versus rural status produced new trends compared with the previously published BoD analysis showing high heterogeneity across the states. CONCLUSIONS We estimated new state-specific asthma incidence rates for the contiguous United States. Using state-specific incidence rates versus a constant national incidence rate resulted in a small change in the NO2 attributable BoD at the national level, but had a more prominent impact at the state level.
Collapse
Affiliation(s)
- Haneen Khreis
- Center for Advancing Research in Transportation, Emissions, Energy, and Health (CARTEEH), Texas A&M Transportation Institute (TTI), College Station, TX; ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain.
| | - Raed Alotaibi
- Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; Texas A&M Health Science Center School of Public Health, TX
| | - Jennifer Horney
- Disaster Research Center, Program in Epidemiology, University of Delaware
| | - Rob McConnell
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles
| |
Collapse
|
46
|
Schyllert C, Lindberg A, Hedman L, Stridsman C, Andersson M, Ilmarinen P, Piirilä P, Krokstad S, Lundbäck B, Rönmark E, Backman H. Low socioeconomic status relates to asthma and wheeze, especially in women. ERJ Open Res 2020; 6:00258-2019. [PMID: 32963998 PMCID: PMC7487352 DOI: 10.1183/23120541.00258-2019] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 05/31/2020] [Indexed: 11/05/2022] Open
Abstract
Low socioeconomic status (SES) has been associated with asthma and wheezing. Occupational group, educational level and income are commonly used indicators for SES, but no single indicator can illustrate the entire complexity of SES. The aim was to investigate how different indicators of SES associate with current asthma, allergic and nonallergic, and asthmatic wheeze. In 2016, a random sample of the population aged 20-79 years in Northern Sweden were invited to a postal questionnaire survey, with 58% participating (n=6854). The survey data were linked to the national Integrated Database for Labour Market Research by Statistics Sweden for the previous calendar year, 2015. Included SES indicators were occupation, educational level and income. Manual workers had increased risk for asthmatic wheeze, and manual workers in service for current asthma, especially allergic asthma. Primary school education associated with nonallergic asthma, whereas it tended to be inversely associated with allergic asthma. Low income was associated with asthmatic wheeze. Overall, the findings were more prominent among women, and interaction analyses between sex and income revealed that women, but not men, with low income had an increased risk both for asthmatic wheeze and current asthma, especially allergic asthma. To summarise, the different indicators of socioeconomic status illustrated various aspects of associations between low SES and asthma and wheeze, and the most prominent associations were found among women.
Collapse
Affiliation(s)
- Christian Schyllert
- Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden
| | - Anne Lindberg
- Dept of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Linnea Hedman
- Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden.,Dept of Health Sciences, Division of Nursing, Luleå University of Technology, Luleå, Sweden
| | - Caroline Stridsman
- Dept of Health Sciences, Division of Nursing, Luleå University of Technology, Luleå, Sweden
| | - Martin Andersson
- Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden
| | - Pinja Ilmarinen
- Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Päivi Piirilä
- Unit of Clinical Physiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Steinar Krokstad
- HUNT Research Centre, Dept of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Levanger, Norway
| | - Bo Lundbäck
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Eva Rönmark
- Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden
| | - Helena Backman
- Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden.,Dept of Health Sciences, Division of Nursing, Luleå University of Technology, Luleå, Sweden
| |
Collapse
|
47
|
Skinner A, Falster K, Gunasekera H, Burgess L, Sherriff S, Deuis M, Thorn A, Banks E. Asthma in urban Aboriginal children: A cross-sectional study of socio-demographic patterns and associations with pre-natal and current carer smoking. J Paediatr Child Health 2020; 56:1448-1457. [PMID: 32841454 DOI: 10.1111/jpc.14991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 05/07/2020] [Accepted: 05/14/2020] [Indexed: 12/01/2022]
Abstract
AIM To describe socio-demographic patterns of asthma prevalence in urban Aboriginal children and quantify associations between asthma prevalence and pre-natal maternal and current carer smoking. METHODS Analyses used carer-reported survey data for 1290 urban Aboriginal children aged 2-17 years from the Study of Environment on Aboriginal Resilience and Child Health. Multilevel log-binomial regression was used to estimate asthma prevalence ratios (PRs) for child- and family-level socio-demographic factors, pre-natal maternal smoking and current carer smoking. Smoking-related PRs were compared with general-population estimates derived from meta-analyses of published cross-sectional data. RESULTS Overall, 33.9% of children had ever had asthma, and 12.9% had received treatment for asthma in the past month. Prevalence estimates declined with increasing household income and increasing household size (posterior probabilities of decreasing trend >0.98), while children exposed to pre-natal maternal smoking had a higher risk of asthma ever than unexposed children (PR 1.18 (95% credible interval 1.00-1.40)). Recently treated asthma prevalence was not significantly associated with pre-natal maternal (0.98 (0.71-1.41)) or current carer smoking (0.97 (0.68-1.37)); however, there was substantial uncertainty in our PR estimates, and 95% credible intervals contained general-population estimates derived from the meta-analyses (1.37 (1.17-1.65) for pre-natal smoking, 1.28 (1.15-1.44) for current parental or household smoking). CONCLUSION Among urban Aboriginal children in the Study of Environment on Aboriginal Resilience and Child Health cohort, asthma prevalence declines as household income and household size increase, while children exposed to pre-natal maternal smoking are at increased risk of ever having asthma. Our results emphasise the importance of reducing smoking in Aboriginal communities, particularly among pregnant women.
Collapse
Affiliation(s)
- Adam Skinner
- The Sax Institute, Sydney, New South Wales, Australia
| | - Kathleen Falster
- The Sax Institute, Sydney, New South Wales, Australia.,National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia.,Centre for Big Data Research in Health, UNSW Australia, Sydney, New South Wales, Australia
| | - Hasantha Gunasekera
- Children's Hospital Westmead Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Leonie Burgess
- The Sax Institute, Sydney, New South Wales, Australia.,National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Simone Sherriff
- The Sax Institute, Sydney, New South Wales, Australia.,The Poche Centre for Indigenous Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Margot Deuis
- Riverina Medical and Dental Aboriginal Corporation, Wagga Wagga, New South Wales, Australia
| | - Allison Thorn
- Tharawal Aboriginal Corporation, Sydney, New South Wales, Australia
| | - Emily Banks
- The Sax Institute, Sydney, New South Wales, Australia.,National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| |
Collapse
|
48
|
Generational Patterns of Asthma Incidence among Immigrants to Canada over Two Decades. A Population-based Cohort Study. Ann Am Thorac Soc 2020; 16:248-257. [PMID: 30395726 DOI: 10.1513/annalsats.201803-187oc] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
RATIONALE Canada, an industrialized country with high endemic asthma rates, is characterized by a large immigrant population. OBJECTIVES We sought to provide insight into the relative contribution of environmental exposure to asthma risk by comparing asthma rates among recent immigrants relative to long-term residents of Canada. METHODS This was a population-based, retrospective cohort study performed using provincial health administrative data for all residents of Ontario, Canada. Residents with and without a diagnosis of asthma from fiscal years 1996-2012 were included. Individuals were categorized as being immigrants (landed in Canada after 1985) or long-term residents of Ontario by linkage with the Immigration, Refugees, and Citizenship Canada's Permanent Resident Database. We calculated the age- and sex-standardized incidence of asthma among residents of Ontario, and compared the incidence of asthma among immigrants and long-term residents using incidence rate ratios (IRRs). RESULTS Analysis of approximately 11.7 million records showed that 2.2 immigrants arrived in Canada during the study period, with over 50% from East and South Asia and the Pacific. We found that asthma incidence was lower among immigrants compared with long-term residents (IRR = 0.30; 95% confidence interval = 0.30-0.30; P < 0.001). However, Ontario-born children of immigrants from most world regions had significantly higher asthma incidence compared with children of long-term residents (IRR = 1.44; 95% confidence interval = 1.43-1.45; P < 0.001). The overall incidence of asthma in Ontario decreased between 1996 and 2012 (Ptrend < 0.001). Immigrants contributed to only a small proportion of the asthma incidence in Ontario, and changes within this group did not significantly affect trends in the overall Ontario population asthma incidence. CONCLUSIONS The higher asthma incidence seen among children of immigrants, but not in their parents, suggests that being born in Canada was critical for determining asthma risk. These findings support the importance of in utero and/or early life exposures on asthma development.
Collapse
|
49
|
Giudice LW, Graff EA, Haripersad Y, Frydrych AM, Parsons R, Kujan O, Farah CS. Chronic disease comorbidity in patients with oral leukoplakia: A matched case-control study. Oral Dis 2020; 26:894-902. [PMID: 32106348 DOI: 10.1111/odi.13315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/11/2020] [Accepted: 02/21/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the presence of chronic diseases in patients with oral leukoplakia (OL) compared to controls matched for age group, gender, smoking and alcohol use. SUBJECTS AND METHODS This case-control study examined the general demographics, medical and social histories of 105 OL cases and 391 controls matched for age group, gender, tobacco and alcohol use. All OL cases were diagnosed based on both clinical and histopathological findings. RESULTS Chronic diseases were significantly associated with OL, namely dyslipidaemia (p < .0001), musculoskeletal diseases (p = .0101) and asthma (p = .0052). The use of ACE inhibitors (p = .0177), opioid analgesics (p = .0300), anticoagulants (p = .0055) and statins (p = .0010) was significantly associated with OL. Dyslipidaemia (p < .0001; odds ratio [95% CI]: 6.4 [3.5-11.6]) and asthma (p = .0110; odds ratio [95% CI]: 2.2 [1.2-4.0]) were identified as independent predictors of OL in multivariate analysis, both of which were significantly more common amongst cases than controls. CONCLUSIONS Results from this first Australian study suggest that dyslipidaemia and asthma may constitute independent predictors for the presence of OL. However, longitudinal studies are needed to ascertain the temporal relationship between OL and chronic disease comorbidity and the mechanisms underlying these associations.
Collapse
Affiliation(s)
- Lance W Giudice
- UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
| | - Emrik A Graff
- UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
| | - Yasmita Haripersad
- UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
| | | | - Richard Parsons
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Bentley, WA, Australia
| | - Omar Kujan
- UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
| | - Camile S Farah
- Australian Centre for Oral Oncology Research & Education, Nedlands, WA, Australia.,Oral, Maxillofacial and Dental Surgery, Fiona Stanley Hospital, Murdoch, WA, Australia
| |
Collapse
|
50
|
Neighborhood-level measures of socioeconomic status are more correlated with individual-level measures in urban areas compared with less urban areas. Ann Epidemiol 2020; 43:37-43.e4. [PMID: 32151518 DOI: 10.1016/j.annepidem.2020.01.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/17/2020] [Accepted: 01/31/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE We tested the hypothesis that individual- and neighborhood-level measures of socioeconomic status (SES) are more concordant in urban than rural areas, and we used the previously established association between obesity and self-rated health to illustrate the effect of residual confounding by individual-level SES when only neighborhood-level SES is considered. METHODS Using data from two population-based surveys, we calculated Spearman's rank correlations between household income and neighborhood socioeconomic advantage across eight Pennsylvania counties. We applied multivariable Poisson regression models with robust variance estimates to estimate the degree to which individual SES confounds the association between obesity and self-rated health when the analysis accounts for neighborhood SES only, and we examined how this confounding varied by county urbanicity. RESULTS Concordance between household income and neighborhood advantage increased with county urbanicity (ρ = 0.16-0.26 vs. 0.31-0.45 vs. 0.47 in medium metro/micropolitan, suburban, and large metro counties, respectively), while confounding by individual SES on the obesity and self-rated health association decreased with urbanicity (15%-22% vs. 6%-13% vs. 3% in medium metro/micropolitan, suburban, and large metro counties, respectively). CONCLUSIONS Individual- and neighborhood-level SES measures are poorly correlated outside of urban areas, suggesting that neighborhood-level measures inadequately account for individual SES in rural settings.
Collapse
|