Sex-specific incidence of asthma, rhinitis and respiratory multimorbidity before and after puberty onset: individual participant meta-analysis of five birth cohorts collaborating in MeDALL

被引：39

作者：

Hohmann, Cynthia ^{[1
]}

Keller, Theresa ^{[1
]}

Gehring, Ulrike ^{[2
]}

Wijga, Alet ^{[3
]}

Standl, Marie ^{[4
]}

Kull, Inger ^{[5
,6
]}

Bergstrom, Anna ^{[7
,8
]}

Lehmann, Irina ^{[9
,10
]}

von Berg, Andrea ^{[11
]}

Heinrich, Joachim ^{[4
,12
]}

Lau, Susanne ^{[13
]}

Wahn, Ulrich ^{[13
]}

Maier, Dieter ^{[14
]}

Anto, Josep ^{[15
,16
]}

Bousquet, Jean ^{[17
,18
]}

Smit, Henriette ^{[19
]}

Keil, Thomas ^{[1
,20
]}

Roll, Stephanie ^{[1
]}

机构：

[1] Charite Univ Med Berlin, Inst Social Med Epidemiol & Hlth Econ, Berlin, Germany

[2] Univ Med Ctr Groningen, Dept Pulmonol, Thoraxctr, Groningen, Netherlands

[3] Natl Inst Publ Hlth & Environm, Bilthoven, Netherlands

[4] Deutsch Forschungszentrum Umwelt & Gesundheit, Helmholtz Zentrum Munchen, Inst Epidemiol, Neuherberg, Germany

[5] Karolinska Inst, Dept Clin Sci & Educ, Stockholm, Sweden

[6] Sachs Childrens Hosp, Stockholm, Sweden

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

[8] Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden

[9] Charite Univ Med Berlin, Mol Epidemiol Unit, Berlin, Germany

[10] Berlin Inst Hlth, Berlin, Germany

[11] Marien Hosp Wesel, Res Inst, Dept Pediat, Wesel, Germany

[12] Ludwig Maximilians Univ Munchen, Inst & Outpatient Clin Occupat Social & Environm, Munich, Germany

[13] Charite Univ Med Berlin, Immunol & Intens Care Unit, Dept Paediat Pneumol, Berlin, Germany

[14] Biomax Informat, Munich, Germany

[15] Univ Pompeu Fabra, Barcelona, Spain

[16] ISGlobal, Barcelona, Spain

[17] Univ Hosp Ctr Montpellier, Montpellier, France

[18] Univ Versailles, UVSQ, UMR S 1168, St Quentin En Yvelines, France

[19] Univ Utrecht, Julius Ctr Hlth Sci & Primary Care, Utrecht, Netherlands

[20] Univ Wurzburg, Inst Clin Epidemiol & Biometry, Wurzburg, Germany

来源：

BMJ OPEN RESPIRATORY RESEARCH | 2019年 / 6卷 / 01期

基金：

瑞典研究理事会; 欧盟第七框架计划;

关键词：

GENDER-DIFFERENCES; PREVALENCE; MECHANISMS; CHILDHOOD; ALLERGY; AGE;

D O I：

10.1136/bmjresp-2019-000460

中图分类号：

R56 [呼吸系及胸部疾病];

学科分类号：

摘要：

Introduction To understand the puberty-related sex shift in the prevalence of asthma and rhinitis as single entities and as respiratory multimorbidities, we investigated if there is also a sex-specific and puberty-related pattern of their incidences. Methods We used harmonised questionnaire data from 18 451 participants in five prospective observational European birth cohorts within the collaborative MeDALL (Mechanisms of the Development of Allergy) project. Outcome definitions for IgE- associated and non-IgE-associated asthma, rhinitis and respiratory multimorbidity ( first occurrence of coexisting asthma and rhinitis) were based on questionnaires and the presence of specific antibodies (IgE) against common allergens in serum. For each outcome, we used proportional hazard models with sex-puberty interaction terms and conducted a one-stage individual participant data meta-analysis. Results Girls had a lower risk of incident asthma (adjusted HR 0.67, 95% CI 0.61 to 0.74), rhinitis (0.73, 0.69 to 0.78) and respiratory multimorbidity (0.58, 0.51 to 0.66) before puberty compared with boys. After puberty onset, these incidences became more balanced across the sexes (asthma 0.84, 0.64 to 1.10; rhinitis 0.90, 0.80 to 1.02; respiratory multimorbidity 0.84, 0.63 to 1.13). The incidence sex shift was slightly more distinct for non-IgE-associated respiratory diseases (asthma 0.74, 0.63 to 0.87 before vs 1.23, 0.75 to 2.00 after puberty onset; rhinitis 0.88, 0.79 to 0.98 vs 1.20, 0.98 to 1.47; respiratory multimorbidity 0.66, 0.49 to 0.88 vs 0.96, 0.54 to 1.71) than for IgE- associated respiratory diseases. Discussion We found an incidence 'sex shift' in chronic respiratory diseases from a male predominance before puberty to a more sex- balanced incidence after puberty onset, which may partly explain the previously reported sex shift in prevalence. These differences need to be considered in public health to enable effective diagnoses and timely treatment in adolescent girls.

引用

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