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Eur J Epidemiol. 2018 Nov 11. doi: 10.1007/s10654-018-0463-z. [Epub ahead of print]

Can environment or allergy explain international variation in prevalence of wheeze in childhood?

Collaborators (150)

Weiland SK, Büchele G, Dentler C, Jaensch A, Rzehak P, Weinmayr G, Priftanji A, Shkurti A, Simenati J, Grabocka E, Shyti K, Agolli S, Gurakuqi A, Stein RT, de Pereira MU, Jones MH, Pitrez PM, Cooper PJ, Chico M, Chen YZ, Zhong NS, Lai CKW, Wong GWK, Riikjärv MA, Annus T, Annesi-Maesano I, Gotua M, Rukhadze M, Abramidze T, Kvachadze I, Karsanidze L, Kiladze M, Dolidze N, Leupold W, Keil U, von Mutius E, Weiland SK, von Mutius E, Keil U, Weiland SK, Arthur P, Addo-Yobo E, Gratziou C, Priftis K, Papadopoulou A, Katsardis C, Tsanakas J, Hatziagorou E, Kirvassilis F, Clausen M, Shah JR, Mathur RS, Khubchandani RP, Mantri S, Forastiere F, Di Domenicantonio R, De Sario M, Sammarro S, Pistelli R, Serra MG, Corbo G, Perucci CA, Svabe V, Sebre D, Casno G, Novikova I, Bagrade L, Brunekreef B, Schram D, Doekes G, Jansen-van Vliet PHN, Janssen NAH, Aarts FJH, de Meer G, Crane J, Wickens K, Barry D, Nystad W, Bolle R, Lund E, Batlles Garrido J, Rubi Ruiz T, Bonillo Perales A, Gonzalez Jiménez Y, Aguirre Rodriguez J, Momblan de Cabo J, Losilla Maldonado A, Daza Torres M, García-Marcos L, Martinez Torres A, Guillén Pérez JJ, Piñana López A, Castejon Robles S, García Hernandez G, Martinez Gimeno A, Moro Rodríguez AL, Luna Paredes C, Gonzalez Gil I, Morales Suarez-Varela MM, Llopis González A, Escribano Montaner A, Tallon Guerola M, Bråbäck L, Kjellman M, Nilsson L, Mai XM, Bråbäck L, Sandin A, Saraçlar Y, Kuyucu S, Tuncer A, Saçkesen C, Sumbulŏglu V, Geyik P, Kocabas C, Strachan DP, Kaur B, El-Sharif N, Nemery B, Barghuthy F, Abu Huij S, Qlebo M, van Hage M, Aït-Khaled N, Anderson HR, Strachan DP, Flohr C, Williams H, Forastiere F, Asher I, Ellwood P, Stewart A, Mitchell E, Crane J, Pearce N, Beasley R, Björkstén B, Brunekreef B, Foliaki S, García-Marcos L, von Mutius E, Keil U, Weiland SK, Weinmayr G, Lai CKW, Wong GWK, Mallol J, Montefort S, Odhiambo J, Robertson C.

Author information

1
Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstraße 22, 89081, Ulm, Germany. Gudrun.Weinmayr@uni-ulm.de.
2
Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstraße 22, 89081, Ulm, Germany.
3
Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.
4
Population Health Research Institute, St George's, University of London, London, UK.

Abstract

Asthma prevalence in children varies substantially around the world, but the contribution of known risk factors to this international variation is uncertain. The International Study of Asthma and Allergies in Childhood (ISAAC) Phase Two studied 8-12 year old children in 30 centres worldwide with parent-completed symptom and risk factor questionnaires and aeroallergen skin prick testing. We used multilevel logistic regression modelling to investigate the effect of adjustment for individual and ecological risk factors on the between-centre variation in prevalence of recent wheeze. Adjustment for single individual-level risk factors changed the centre-level variation from a reduction of up to 8.4% (and 8.5% for atopy) to an increase of up to 6.8%. Modelling the 11 most influential environmental factors among all children simultaneously, the centre-level variation changed little overall (2.4% increase). Modelling only factors that decreased the variance, the 6 most influential factors (synthetic and feather quilt, mother's smoking, heating stoves, dampness and foam pillows) in combination resulted in a 21% reduction in variance. Ecological (centre-level) risk factors generally explained higher proportions of the variation than did individual risk factors. Single environmental factors and aeroallergen sensitisation measured at the individual (child) level did not explain much of the between-centre variation in wheeze prevalence.

KEYWORDS:

Asthma; Child; Environmental risk factors; Hypersensitivity; International variation

PMID:
30415436
DOI:
10.1007/s10654-018-0463-z

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