US Childhood Asthma Incidence Rate Patterns From the ECHO Consortium to Identify High-risk Groups for Primary Prevention
US Childhood Asthma Incidence Rate Patterns From the ECHO Consortium to Identify High-risk Groups for Primary Prevention
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DOI：
10.1001/jamapediatrics.2021.0667
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发表时间：
2021-05-17
期刊：
影响因子：
26.1
通讯作者：
Togias, Alkis
中科院分区：
文献类型：
--
作者：
Johnson, Christine Cole;Chandran, Aruna;Togias, Alkis
哮喘是美国儿童的主要慢性疾病，但大多数描述性流行病学数据都集中在患病率上。目的评估全国儿童哮喘发病率、核心人口阶层及父母哮喘史。设计、环境和参与者本队列研究在环境对儿童健康结局的影响（ECHO）联盟中对1980年5月1日至2018年3月31日收集的数据进行了分布式荟萃分析。我们纳入了来自ECHO联盟31个队列的34孕周及以上至18岁儿童的出生队列数据。数据分析时间为2018年6月14日至2020年2月18日。暴露：医生诊断的哮喘的护理人员报告与诊断年龄。使用Kaplan-Meier方法将每个队列产生的哮喘发病率生存表与各年龄相结合。计算各阶层的年龄特异性发病率和父母家族史（FH）、性别和种族/民族哮喘发病率比。结果纳入初步分析的1404名儿童（平均[SD]年龄10.0[0.7]岁，5836名男孩[51%]，5909名白人儿童[53%]）中，7326名儿童（64%）无哮喘FH， 4078名（36%）有哮喘FH， 2494名（23%）为非西班牙裔黑人儿童。患有FH的儿童在出生后第四年的发病率高出近2倍（发病率比[IRR]， 1.94; 95% CI, 1.76-2.16），之后与非FH组的发病率趋于一致。不考虑FH， 4岁无FH的非西班牙裔黑人儿童学龄前哮喘发病率显著高于非西班牙裔白人儿童（IRR, 1.58; 95% CI, 1.31-1.86）， 9 - 10岁无FH的非西班牙裔黑人儿童哮喘发病率低于白人儿童（IRR, 0.67; 95% CI, 0.50-0.89）。男孩的发病率随着年龄的增长而下降，而女孩的发病率在所有年龄段都相对稳定，特别是在那些没有哮喘的女性中。对这些不同出生队列的相关性分析表明，哮喘FH以及种族/民族和性别都与儿童哮喘发病率相关。黑人儿童的发病率要高得多，但仅在学龄前，与FH无关。为了预防患有哮喘的儿童或黑人婴儿的哮喘，研究结果表明，干预措施应该针对早期生活。
IMPORTANCE Asthma is the leading chronic illness in US children, but most descriptive epidemiological data are focused on prevalence.OBJECTIVE To evaluate childhood asthma incidence rates across the nation by core demographic strata and parental history of asthma.DESIGN, SETTING, AND PARTICIPANTS For this cohort study, a distributed meta-analysis was conducted within the Environmental Influences on Child Health Outcomes (ECHO) consortium for data collected from May 1, 1980, through March 31, 2018. Birth cohort data of children from 34 gestational weeks of age or older to 18 years of age from 31 cohorts in the ECHO consortium were included. Data were analyzed from June 14, 2018, to February 18, 2020.EXPOSURES Caregiver report of physician-diagnosed asthma with age of diagnosis.MAIN OUTCOME AND MEASURES Asthma incidence survival tables generated by each cohort were combined for each year of age using the Kaplan-Meier method. Age-specific incidence rates for each stratum and asthma incidence rate ratios by parental family history (FH), sex, and race/ethnicity were calculated.RESULTS Of the 11 404 children (mean [SD] age, 10.0 [0.7] years; 5836 boys [51%]; 5909 White children [53%]) included in the primary analysis, 7326 children (64%) had no FH of asthma, 4078 (36%) had an FH of asthma, and 2494 (23%) were non-Hispanic Black children. Children with an FH had a nearly 2-fold higher incidence rate through the fourth year of life (incidence rate ratio [IRR], 1.94; 95% CI, 1.76-2.16) after which the rates converged with the non-FH group. Regardless of FH, asthma incidence rates among non-Hispanic Black children were markedly higher than those of non-Hispanic White children during the preschool years (IRR, 1.58; 95% CI, 1.31-1.86) with no FH at age 4 years and became lower than that of White children after age 9 to 10 years (IRR, 0.67; 95% CI, 0.50-0.89) with no FH. The rates for boys declined with age, whereas rates among girls were relatively steady across all ages, particularly among those without an FH of asthma.CONCLUSIONS AND RELEVANCE Analysis of these diverse birth cohorts suggests that asthma FH, as well as race/ethnicity and sex, were all associated with childhood asthma incidence rates. Black children had much higher incidences rates but only during the preschool years, irrespective of FH. To prevent asthma among children with an FH of asthma or among Black infants, results suggest that interventions should be developed to target early life.