Are environmental risk factors for current wheeze in the International Study of Asthma and Allergies in Childhood (ISAAC) phase three due to reverse causation?

被引：19

作者：

Silverwood, Richard J. ^{[1
]}

Rutter, Charlotte E. ^{[1
]}

Mitchell, Edwin A. ^{[2
]}

Asher, M. Innes ^{[2
]}

Garcia-Marcos, Luis ^{[3
,4
,5
]}

Strachan, David P. ^{[6
]}

Pearce, Neil ^{[1
,7
]}

Ait-Khaled, N. ^{[8
]}

Anderson, H. R. ^{[6
]}

Asher, M. I. ^{[2
,97
]}

Beasley, R. ^{[9
]}

Bjorksten, B. ^{[10
]}

Brunekreef, B. ^{[11
]}

Crane, J. ^{[12
]}

Ellwood, P. ^{[2
]}

Flohr, C. ^{[13
,14
]}

Foliaki, S. ^{[15
]}

Forastiere, F. ^{[16
]}

Garcia-Marcos, L. ^{[17
,121
,122
]}

Keil, U. ^{[18
]}

Lai, C. K. W. ^{[19
]}

Mallol, J. ^{[20
]}

Mitchell, E. A. ^{[2
]}

Montefort, S. ^{[21
,85
]}

Odhiambo, J. ^{[22
]}

Pearce, N. ^{[23
,101
]}

Robertson, C. F. ^{[24
]}

Stewart, A. W. ^{[25
,32
]}

Strachan, D. ^{[26
,138
]}

von Mutius, E. ^{[27
]}

Weiland, S. K. ^{[28
]}

Weinmayr, G. ^{[29
]}

Williams, H. C. ^{[30
]}

Wong, G. ^{[31
,113
]}

Asher, M. I. ^{[2
,97
]}

Clayton, T. O. ^{[2
]}

Ellwood, P. ^{[2
]}

Mitchell, E. A. ^{[2
]}

Stewart, A. W. ^{[25
,32
]}

Baena-Cagnani, C. E. ^{[33
]}

Gomez, M. ^{[34
]}

Howitt, M. E. ^{[35
]}

Weyler, J. ^{[36
]}

Pinto-Vargas, R. ^{[37
]}

da Cunha, A. J. ^{[38
]}

de Freitas Souza, L. ^{[39
]}

Kuaban, C. ^{[40
]}

Ferguson, A. ^{[41
]}

Rennie, D. ^{[42
]}

Standring, P. ^{[43
]}

机构：

[1] London Sch Hyg & Trop Med, Dept Med Stat, London, England

[2] Univ Auckland, Dept Paediat Child & Youth Hlth, Fac Med & Hlth Sci, Auckland, New Zealand

[3] Univ Murcia, Pediat Allergy Unit, Virgen Arrixaca Univ, Childrens Hosp, Murcia, Spain

[4] Univ Murcia, Pulmonol Unit, Virgen Arrixaca Univ, Childrens Hosp, Murcia, Spain

[5] IMIB Biores Inst, Murcia, Spain

[6] St Georges Univ London, Populat Hlth Res Inst, London, England

[7] London Sch Hyg & Trop Med, Ctr Global NCDs, London, England

[8] Int Union TB & Lung Dis, Paris, France

[9] Med Res Inst New Zealand, Wellington, New Zealand

[10] Karolinska Inst, Inst Environm Med, Stockholm, Sweden

[11] Univ Utrecht, Inst Risk Assessment Sci, Utrecht, Netherlands

[12] Wellington Sch Med, Wellington Asthma Res Grp, Wellington, New Zealand

[13] Guys & St Thomas NHS Fdn Trust, Unit Populat Based Dermatol Res, St Johns Inst Dermatol, London, England

[14] Kings Coll London, London, England

[15] Massey Univ, Ctr Publ Hlth Res, Wellington, New Zealand

[16] Local Hlth Author, Dept Epidemiol, Rome, Italy

[17] Biohlth Res Inst Murcia IMIB, Murcia, Spain

[18] Univ Munster, Inst Epidemiol & Sozialmed, Munster, Germany

[19] Chinese Univ Hong Kong, Dept Med & Therapeut, Hong Kong, Peoples R China

[20] Univ Santiago Chile, Dept Resp Med, Santiago, Chile

[21] Univ Malta, Dept Med, Msida, Malta

[22] Kenya Govt Med Res Ctr, Ctr Resp Dis Res Unit, Nairobi, Kenya

[23] London Sch Hyg & Trop Med, Fac Epidemiol & Populat Hlth, London, England

[24] Murdoch Childrens Res Inst, Melbourne, Vic, Australia

[25] Univ Auckland, Fac Med & Hlth Sci, Populat Hlth, Auckland, New Zealand

[26] St Georges Univ London, Populat Hlth Res Inst, London, England

[27] Univ Munich, Dr von Haunerschen Kinderklin, Munich, Germany

[28] Univ Ulm, Inst Epidemiol, Ulm, Germany

[29] Univ Ulm, Inst Epidemiol & Med Biometry, Ulm, Germany

[30] Univ Nottingham, Ctr Evidence Based Dermatol, Nottingham, England

[31] Prince Wales Hosp, Dept Paediat, Hong Kong, Peoples R China

[32] Univ Auckland, Fac Med & Hlth Sci, Sch Populat Hlth, Auckland, New Zealand

[33] Catholic Univ Cordoba, Cordoba, Argentina

[34] Hosp San Bernardo Salta, Ayre Fdn, Salta, Argentina

[35] Carlton Clin, Bridgetown, Barbados

[36] Univ Antwerp, Antwerp, Belgium

[37] Caja Petr Salud, Santa Cruz, Bolivia

[38] Univ Fed Rio de Janeiro, Nova Iguacu, Brazil

[39] Univ Fed Bahia, Salvador, Vitoria Da Conq, Brazil

[40] Univ Yaounde, Yaounde, Cameroon

[41] Univ British Columbia, Vancouver, BC, Canada

[42] Univ Saskatchewan, Saskatoon, SK, Canada

[43] Princess Elizabeth Hosp, Guernsey, England

[44] Hosp CRS El Pino, South Santiago, Chile

[45] Reg Hosp Lautaro Navarro, Punta Arenas, Chile

[46] Hosp Castro, Chiloe, Chile

[47] Peking Univ, Training Hosp, Beijing, Tong Zhou, Peoples R China

[48] Univ Tokyo, Tibet, Japan

[49] Xinjiang Childrens Hosp, Urumqi, Peoples R China

[50] Guangzhou Inst Resp Dis, Guangzhou, Guangdong, Peoples R China

来源：

CLINICAL AND EXPERIMENTAL ALLERGY | 2019年 / 49卷 / 04期

基金：

欧洲研究理事会; 英国医学研究理事会; 英国惠康基金;

关键词：

asthma; environment and hygiene hypothesis; epidemiology; GLOBAL FINDINGS; RHINOCONJUNCTIVITIS; ECZEMA; SYMPTOMS; PREVALENCE; CHILDREN; ASSOCIATION; RATIONALE; EXPOSURE; INFANCY;

D O I：

10.1111/cea.13325

中图分类号：

R392 [医学免疫学];

学科分类号：

100102 ;

摘要：

Background: Phase Three of the International Study of Asthma and Allergies in Childhood (ISAAC) measured the global prevalence of symptoms of asthma in children. We undertook comprehensive analyses addressing risk factors for asthma symptoms in combination, at both the individual and the school level, to explore the potential role of reverse causation due to selective avoidance or confounding by indication. Objective: To explore the role of reverse causation in risk factors of asthma symptoms. Methods: We compared two sets of multilevel logistic regression analyses, using (a) individual level exposure data and (b) school level average exposure (ie prevalence), in two different age groups. In individual level analyses, reverse causation is a possible concern if individual level exposure statuses were changed as a result of asthma symptoms or diagnosis. School level analyses may suffer from ecologic confounding, but reverse causation is less of a concern because individual changes in exposure status as a result of asthma symptoms would only have a small effect on overall school exposure levels. Results: There were 131 924 children aged 6-7 years (2428 schools, 25 countries) with complete exposure, outcome and confounder data. The strongest associations in individual level analyses (fully adjusted) were for current paracetamol use (odds ratio = 2.06; 95% confidence interval 1.97-2.16), early life antibiotic use (1.65; 1.58-1.73) and open fire cooking (1.44; 1.26-1.65). In school level analyses, these risk factors again showed increased risks. There were 238 586 adolescents aged 13-14 years (2072 schools, 42 countries) with complete exposure, outcome and confounder data. The strongest associations in individual level analyses (fully adjusted) were for current paracetamol use (1.80; 1.75-1.86), cooking on an open fire (1.32; 1.22-1.43) and maternal tobacco use (1.23; 1.18-1.27). In school level analyses, these risk factors again showed increased risks. Conclusions & clinical relevance: These analyses strengthen the potentially causal interpretation of previously reported individual level findings, by providing evidence against reverse causation.

引用

页码：430 / 441

页数：12

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