Early childhood wheezing phenotypes and determinants in a South African birth cohort: longitudinal analysis of the Drakenstein Child Health Study

被引:28
作者
McCready, Carlyle [2 ,3 ,4 ]
Haider, Sadia [6 ]
Little, Francesca [2 ]
Nicol, Mark P. [7 ]
Workman, Lesley [3 ,4 ]
Gray, Diane M. [3 ,4 ]
Granell, Raquel [8 ]
Stein, Dan J. [5 ]
Custovic, Adnan [6 ]
Zar, Heather J. [1 ,3 ,4 ]
机构
[1] Univ Cape Town, Dept Paediat & Child Hlth, ZA-8001 Cape Town, South Africa
[2] Dept Stat Sci, Cape Town, South Africa
[3] Dept Paediat & Child Hlth, Cape Town, South Africa
[4] SA Med Res Council Unit Child & Adolescent Hlth, Cape Town, South Africa
[5] Resilience Univ Cape Town, Med Res Council Unit Risk, Dept Psychiat & Mental Hlth, Cape Town, South Africa
[6] Natl Heart & Lung Inst, Imperial Coll London, London, England
[7] Univ Western Australia, Marshall Ctr, Sch Biomed Sci, Perth, WA, Australia
[8] Univ Bristol, Bristol Med Sch, Med Res Council Integrat Epidemiol Unit, Dept Populat Hlth Sci, Bristol, England
基金
英国惠康基金; 美国国家卫生研究院; 比尔及梅琳达.盖茨基金会; 英国医学研究理事会;
关键词
RHINOVIRUS ILLNESSES; LOW-INCOME; LIFE; ASTHMA; DISEASE; RISK;
D O I
10.1016/S2352-4642(22)00304-2
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Background Developmental trajectories of childhood wheezing in low-income and middle-income countries (LMICs) have not been well described. We aimed to derive longitudinal wheeze phenotypes from birth to 5 years in a South African birth cohort and compare those with phenotypes derived from a UK cohort.Methods We used data from the Drakenstein Child Health Study (DCHS), a longitudinal birth cohort study in a peri-urban area outside Cape Town, South Africa. Pregnant women (aged >= 18 years) were enrolled during their second trimester at two public health clinics. We followed up children from birth to 5 years to derive six multidimensional indicators of wheezing (including duration, temporal sequencing, persistence, and recurrence) and applied Partition Around Medoids clustering to derive wheeze phenotypes. We compared phenotypes with a UK cohort (the Avon Longitudinal Study of Parents and Children [ALSPAC]). We investigated associations of phenotypes with early-life exposures, including all-cause lower respiratory tract infection (LRTI) and virus-specific LRTI (respiratory syncytial virus, rhinovirus, adenovirus, influenza, and parainfluenza virus) up to age 5 years. We investigated the association of phenotypes with lung function at 6 weeks and 5 years. Findings Between March 5, 2012, and March 31, 2015, we enrolled 1137 mothers and there were 1143 livebirths. Four wheeze phenotypes were identified among 950 children with complete data: never (480 children [50%]), early transient (215 children [23%]), late onset (104 children [11%]), and recurrent (151 children [16%]). Multivariate adjusted analysis indicated that LRTI and respiratory syncytial virus-LRTI, but not other respiratory viruses, were associated with increased risk of recurrent wheeze (odds ratio [OR] 2 center dot 79 [95% CI 2 center dot 05-3 center dot 81] for all LTRIs; OR 2 center dot 59 [1 center dot 30-5 center dot 15] for respiratory syncytial virus-LRTIs). Maternal smoking (1 center dot 88 [1 center dot 12-3 center dot 02]), higher socioeconomic status (2 center dot 46 [1 center dot 23-4 center dot 91]), intimate partner violence (2 center dot 01 [1 center dot 23-3 center dot 29]), and male sex (2 center dot 47 [1 center dot 50-4 center dot 04]) were also associated with recurrent wheeze. LRTI and respiratory syncytial virus-LRTI were also associated with early transient and late onset clusters. Wheezing illness architecture differed between DCHS and ALSPAC; children included in ALSPAC in the early transient cluster wheezed for a longer period before remission and late-onset wheezing started at an older age, and no persistent phenotype was identified in DCHS. At 5 years, airway resistance was higher in children with early or recurrent wheeze compared with children who had never wheezed. Airway resistance increased from 6 weeks to 5 years among children with recurrent wheeze.Interpretation Effective strategies to reduce maternal smoking and psychosocial stressors and new preventive interventions for respiratory syncytial virus are urgently needed to optimise child health in LMICs.
引用
收藏
页码:127 / 135
页数:9
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