Asthma prevalence, family size, and birth order
Asthma prevalence, family size, and birth order
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DOI：
10.1378/chest.06-2818
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发表时间：
2007-06-01
期刊：
影响因子：
9.6
通讯作者：
Picard, Elie
中科院分区：
文献类型：
--
作者：
Goldberg, Shmuel;Israeli, Eran;Picard, Elie
背景：在大家庭中，哮喘患病率可能会降低。卫生假说认为，哥哥姐姐通过调节仍在成熟的免疫系统来保护弟弟妹妹免受哮喘的侵害。如果卫生假说是正确的，哮喘患病率应该与出生顺序成反比。本研究的目的是探讨哮喘患病率与家庭规模和出生顺序之间的关系。方法：对531116名以色列义务兵的病历资料进行回顾性分析。评估了家庭子女数量与哮喘患病率之间的关系，以及出生顺序与哮喘患病率之间的关系。根据出生顺序和家庭规模计算哮喘的优势比，并进行相互调整。结果：男性26,33例（8.6%），女性15,079例（6.9%）。哮喘患病率与家庭子女数呈负相关（p < 0.001）。在独生子女中，哮喘患病率为7.3%。在有3个兄弟姐妹的家庭中患病率上升至8.95%，然后随着兄弟姐妹数量的增加而逐渐下降，在有15至20个兄弟姐妹的家庭中达到0.58%的低谷。所有出生顺序的哮喘患病率相似。结论：在有四个或更多孩子的家庭中，哮喘患病率与家庭中孩子的数量呈负相关。所有出生顺序的哮喘患病率相似。所有出生顺序相似的哮喘患病率挑战了卫生学假说，即在大家庭中哮喘患病率降低的机制。
Background: Asthma prevalence may be reduced in large families. The hygiene hypothesis suggests that older siblings protect their younger siblings from asthma through a modulating effect on the still-maturing immune system. If the hygiene hypothesis is correct, asthma prevalence should be inversely related to birth order. The objective of this study was to examine the relationship between asthma prevalence, and family size and birth order.Methods: The medical records of 531,116 Israeli military conscripts were reviewed. The association between number of children in the family and the prevalence of asthma, and between birth order and the prevalence of asthma was assessed. Odds ratios for asthma by birth order and family size, adjusted for each other, were calculated.Results: Asthma was diagnosed in 26,S33 male subjects (8.6%) and 15,079 female subjects (6.9%). Asthma prevalence was inversely related to the number of children in the family (p < 0.001). Among subjects who were the only child in the family, the prevalence of asthma was 7.3%. The prevalence increased to 8.95% among subjects from families with three siblings, and then progressively decreased as the number of siblings increased, and reached a trough of 0.58% in conscripts from families of 15 to 20 siblings. Asthma prevalence was similar for all birth orders.Conclusions: In families with four or more children, asthma prevalence is inversely related to the number of children in the family. Asthma prevalence is similar for all birth orders. The similar asthma prevalence for all birth orders challenges the hygiene hypothesis as the mechanism for the decreased asthma prevalence in large families.