Exposure to secondhand smoke and asthma severity among children in Connecticut
Exposure to secondhand smoke and asthma severity among children in Connecticut
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DOI：
10.1371/journal.pone.0174541
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发表时间：
2017-03-31
期刊：
影响因子：
3.7
通讯作者：
Cloutier, Michelle M.
中科院分区：
文献类型：
--
作者：
Hollenbach, Jessica P.;Schifano, Elizabeth D.;Cloutier, Michelle M.
目的确定是否二手烟（SHS）暴露与更大的哮喘严重程度的儿童与医生诊断的哮喘生活在CT，并检查是否居住区，种族/民族或贫困中度association.MethodsA大型儿童哮喘数据库CT（轻松呼吸）的参与者邮政编码人口普查数据，按居住区对参与者进行分类。采用多项logistic回归模型，调整入组日期、性别、年龄、种族/民族、居住地区、保险类型、哮喘、湿疹家族史以及暴露于狗、猫、煤气炉、啮齿动物和蟑螂等因素，以检查自我报告的SHS暴露与临床医生确定的哮喘严重程度之间的关系结果在Easy Breathing登记的30,163名哮喘儿童中，年龄在6个月至18岁之间，居住在CT的161个不同城镇，暴露于SHS与更严重的哮喘相关（轻度和中度持续性哮喘的校正相对危险比（aRRR）分别为1.07 [1.00，1.15]和aRRR：1.11 [1.02，1.22]）。黑人和波多黎各/西班牙裔哮喘儿童暴露于SHS的几率是白人儿童的两倍。虽然公共保险的哮喘儿童接触SHS的几率是私人保险儿童的三倍，（OR：3.02 [2.84，3，21]），SHS暴露仅在私人保险儿童中与持续性哮喘相关（调整后的比值比（aOR）：1.23 [1.11，1.37]）.结论这是第一个大规模的实用研究，以证明暴露于SHS在康涅狄格州的儿童有更大的哮喘严重程度，使用系统方法临床确定，并因保险状况而异。
ObjectiveTo determine whether secondhand smoke (SHS) exposure is associated with greater asthma severity in children with physician-diagnosed asthma living in CT, and to examine whether area of residence, race/ethnicity or poverty moderate the association.MethodsA large childhood asthma database in CT (Easy Breathing) was linked by participant zip code to census data to classify participants by area of residence. Multinomial logistic regression models, adjusted for enrollment date, sex, age, race/ethnicity, area of residence, insurance type, family history of asthma, eczema, and exposure to dogs, cats, gas stove, rodents and cockroaches were used to examine the association between self-reported exposure to SHS and clinician-determined asthma severity (mild, moderate, and severe persistent vs. intermittent asthma).ResultsOf the 30,163 children with asthma enrolled in Easy Breathing, between 6 months and 18 years old, living in 161 different towns in CT, exposure to SHS was associated with greater asthma severity (adjusted relative risk ratio (aRRR): 1.07 [1.00, 1.15] and aRRR: 1.11 [1.02, 1.22] for mild and moderate persistent asthma, respectively). The odds of Black and Puerto Rican/Hispanic children with asthma being exposed to SHS were twice that of Caucasian children. Though the odds of SHS exposure for publicly insured children with asthma were three times greater than the odds for privately insured children (OR: 3.02 [2.84,3,21]), SHS exposure was associated with persistent asthma only among privately insured children (adjusted odds ratio (aOR): 1.23 [1.11,1.37]).ConclusionThis is the first large-scale pragmatic study to demonstrate that children exposed to SHS in Connecticut have greater asthma severity, clinically determined using a systematic approach, and varies by insurance status.