Are Environmental Factors for Atopic Eczema in ISAAC Phase Three due to Reverse Causation?

被引：12

作者：

Rutter, Charlotte E. ^{[1
]}

Silverwood, Richard J. ^{[1
]}

Williams, Hywel C. ^{[2
]}

Ellwood, Philippa ^{[3
]}

Asher, Innes ^{[3
]}

Garcia-Marcos, Luis ^{[4
]}

Strachan, David P. ^{[5
]}

Pearce, Neil ^{[1
,6
,7
]}

Langan, Sinead M. ^{[1
]}

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

Anderson, H. R. ^{[5
]}

Asher, M., I ^{[9
,31
,99
]}

Beasley, R. ^{[10
]}

Bjorksten, B. ^{[11
]}

Brunekreef, B. ^{[12
]}

Crane, J. ^{[13
]}

Ellwood, P. ^{[9
,31
]}

Flohr, C. ^{[14
,15
]}

Foliaki, S. ^{[7
]}

Forastiere, F. ^{[16
]}

Garcia-Marcos, L. ^{[17
,18
]}

Keil, U. ^{[19
]}

Lai, C. K. W. ^{[20
]}

Mallol, J. ^{[21
]}

Mitchell, E. A. ^{[9
,31
]}

Montefort, S. ^{[22
,87
]}

Odhiambo, J. ^{[23
]}

Pearce, N. ^{[24
,103
]}

Robertson, C. F. ^{[25
]}

Stewart, A. W. ^{[26
,32
]}

Strachan, D. ^{[5
]}

von Mutius, E. ^{[27
]}

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

Weinmayr, G. ^{[29
]}

Williams, H. C. ^{[2
]}

Wong, G. ^{[30
]}

Clayton, T. O. ^{[31
]}

Ellwood, E. ^{[31
]}

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
]}

Aguilar, P. ^{[44
]}

机构：

[1] London Sch Hyg & Trop Med, Fac Epidemiol & Populat Hlth, Keppel St, London WC1E 7HT, England

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

[3] Univ Auckland, Dept Paediat Child & Youth Hlth, Auckland, New Zealand

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

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

[6] Red Asma Reacc Adversas & Alerg, Madrid, Spain

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

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

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

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

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

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

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

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

[15] Kings Coll London, London, England

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

[17] Univ Murcia, Virgen Arrixaca Univ Childrens Hosp, Marcos Pediat Allergy & Pulmonol Units, Murcia, Spain

[18] Bio Hlth Res Inst Murcia IMIB, Murcia, Spain

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

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

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

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

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

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

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

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

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

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

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

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

[31] Dept Paediat Child & Youth Hlth, Hong Kong, Peoples R China

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

[33] Catholic Univ Cordoba, Cordoba, Spain

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

[35] Carlton Clin, Bridgetown, Barbados

[36] Univ Antwerp, Antwerp, Belgium

[37] Caja Petrolera Salud, Santa Cruz, Brazil

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

[39] Univ Fed Bahia Feira Santana, Vitoria Conquista, Salvador, BA, Brazil

[40] Univ Yaounde, Yaounde, Cameroon

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

[42] Univ Saskatchewan, Channel Isl, Saskatoon, SK, Canada

[43] Princess Elizabeth Hosp, Guernsey, Chile

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

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

[46] Hosp Castro, Chiloe, Peoples R China

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

[48] Univ Tokyo, Tokyo, Japan

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

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

来源：

JOURNAL OF INVESTIGATIVE DERMATOLOGY | 2019年 / 139卷 / 05期

基金：

英国医学研究理事会; 欧洲研究理事会;

关键词：

EARLY-LIFE EXPOSURE; CHILDHOOD ISAAC; GLOBAL ANALYSIS; FAMILY IMPACT; BIRTH-WEIGHT; ASTHMA; RHINOCONJUNCTIVITIS; ALLERGIES; RISK; SYMPTOMS;

D O I：

10.1016/j.jid.2018.08.035

中图分类号：

R75 [皮肤病学与性病学];

学科分类号：

100206 ;

摘要：

Some previously described environmental associations for atopic eczema may be due to reverse causation. We explored the role of reverse causation by comparing individual-and school-level results for multiple atopic eczema risk factors. The International Study of Asthma and Allergies in Childhood (i.e, ISAAC) Phase Three surveyed children in schools (the sampling unit) regarding atopic eczema symptoms and potential risk factors. We assessed the effect of these risk factors on atopic eczema symptoms using mixed-effect logistic regression models, first with individual-level exposure data and second with school-level exposure prevalence. Overall, 546,348 children from 53 countries were included. At ages 6-7 years, the strongest individual-level associations were with current paracetamol use (odds ratio [OR] = 1.45, 95% confidence interval [CI] = 1.37-1.54), which persisted at school-level (OR = 1.55, 95% CI = 1.10-2.21), early-life antibiotics (OR = 1.41, 95% CI = 1.34-1.48), and early-life paracetamol use (OR = 1.28, 95% CI = 1.21-1.36), with the former persisting at the school level, whereas the latter was no longer observed (OR = 1.35, 95% CI = 1.00-1.82 and OR = 0.94, 95% CI = 0.69-1.28, respectively). At ages 13-14 years, the strongest associations at the individual level were with current paracetamol use (OR = 1.57, 95% CI = 1.51-1.63) and open-fire cooking (OR = 1.46, 95% CI = 1.33-1.62); both were stronger at the school level (OR = 2.57, 95% CI = 1.84-3.59 and OR = 2.38, 95% CI = 1.52-3.73, respectively). Association with exposure to heavy traffic (OR = 1.31, 95% CI = 1.27-1.36) also persisted at the school level (OR = 1.40, 95% CI = 1.07-1.82). Most individual-and school-level effects were consistent, tending to exclude reverse causation.

引用

页码：1023 / 1036

页数：14

共 19 条

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Silverwood, Richard J.
Rutter, Charlotte E.
Mitchell, Edwin A.
Asher, M. Innes
Garcia-Marcos, Luis
Strachan, David P.
Pearce, Neil
Ait-Khaled, N.
Anderson, H. R.
Asher, M. I.
Beasley, R.
Bjorksten, B.
Brunekreef, B.
Crane, J.
Ellwood, P.
Flohr, C.
Foliaki, S.
Forastiere, F.
Garcia-Marcos, L.
Keil, U.
Lai, C. K. W.
Mallol, J.
Mitchell, E. A.
Montefort, S.
Odhiambo, J.
Pearce, N.
Robertson, C. F.
Stewart, A. W.
Strachan, D.
von Mutius, E.
Weiland, S. K.
Weinmayr, G.
Williams, H. C.
Wong, G.
Asher, M. I.
Clayton, T. O.
Ellwood, P.
Mitchell, E. A.
Stewart, A. W.
Baena-Cagnani, C. E.
Gomez, M.
Howitt, M. E.
Weyler, J.
Pinto-Vargas, R.
da Cunha, A. J.
de Freitas Souza, L.
Kuaban, C.
Ferguson, A.
Rennie, D.
Standring, P.
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