Are environmental risk factors for current wheeze in the International Study of Asthma and Allergies in Childhood (ISAAC) phase three due to reverse causation?
Are environmental risk factors for current wheeze in the International Study of Asthma and Allergies in Childhood (ISAAC) phase three due to reverse causation?
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国际儿童哮喘和过敏研究 (ISAAC) 第三阶段中当前喘息的环境风险因素是否是由于反向因果关系造成的？
DOI：
10.1111/cea.13325
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Silverwood RJ
中科院分区：
文献类型：
--
作者：
Silverwood RJ
背景儿童哮喘和过敏症国际研究(ISAC)的第三阶段测量了儿童哮喘症状的全球流行率。我们从个人和学校两个层面对哮喘症状的危险因素进行了综合分析，以探索选择性回避或指示混淆的反向因果关系的潜在作用。目的探讨反向因果关系在哮喘症状危险因素中的作用。方法采用(A)个人水平暴露数据和(B)学校水平平均暴露(即患病率)两组多水平Logistic回归分析。在个人水平分析中，如果个人水平暴露状态因哮喘症状或诊断而改变，则可能存在反向因果关系。学校层面的分析可能会受到生态混乱的影响，但反向因果关系并不那么令人担忧，因为哮喘症状导致的暴露状态的个体变化只会对总体学校暴露水平产生很小的影响。结果共有131 924名6-7岁的儿童(25个国家的2428所学校)获得了完整的暴露、结果和混淆数据。在个体水平分析(完全调整)中，最强的关联是当前使用扑热息痛(优势比=2.06；95%可信区间1.97-2.16)、早期使用抗生素(1.65；1.58-1.73)和露天烹饪(1.44；1.26-1.65)。在学校层面的分析中，这些危险因素再次显示风险增加。有238586名13-14岁的青少年(42个国家的2072所学校)拥有完整的暴露、结果和混淆数据。在个人水平分析(完全调整)中，关联最强的是当前使用扑热息痛(1.80；1.75-1.86)、在明火上做饭(1.32；1.22-1.43)和母亲使用烟草(1.23；1.18-1.27)。在学校层面的分析中，这些危险因素再次显示出增加的风险。结论和临床相关性这些分析通过提供反对反向因果关系的证据，加强了对先前报道的个人水平结果的潜在因果解释。
BackgroundPhase 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.ObjectiveTo explore the role of reverse causation in risk factors of asthma symptoms.MethodsWe 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.ResultsThere 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 relevanceThese analyses strengthen the potentially causal interpretation of previously reported individual level findings, by providing evidence against reverse causation.
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影响因子：
4.4
作者：
E. Mitchell;T. Clayton;L. García‐Marcos;N. Pearce;S. Foliaki;G. Wong
通讯作者：
G. Wong
DOI：
10.1016/s2213-2600(13)70073-0
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期刊：
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扑热息痛是过敏性疾病的危险因素
DOI：
10.1016/s0140-6736(09)60030-1
发表时间：
2009
期刊：
The Lancet
影响因子：
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作者：
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通讯作者：
K. Allen
DOI：
10.1111/cea.12349
发表时间：
2015-01
期刊：
Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology
影响因子：
--
作者：
Strachan DP;Aït-Khaled N;Foliaki S;Mallol J;Odhiambo J;Pearce N;Williams HC;ISAAC Phase Three Study Group
通讯作者：
ISAAC Phase Three Study Group
鼻炎 国际儿童哮喘和过敏研究 (ISAAC) 第三阶段中当前喘息的环境危险因素是否是由于反向因果关系造成的？
DOI：
--
发表时间：
2019
期刊：
影响因子：
--
作者：
R. Silverwood;Charlotte E Rutter;E. A. Mitchell;M. Asher;Luis García;Marcos;D. Strachan;N. Pearce
通讯作者：
N. Pearce