Childhood wheezing, asthma, allergy, atopy, and lung function: different socioeconomic patterns for different phenotypes.
Childhood wheezing, asthma, allergy, atopy, and lung function: different socioeconomic patterns for different phenotypes.
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DOI：
10.1093/aje/kwv045
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发表时间：
2015-11-01
影响因子：
5
通讯作者：
Henderson J
中科院分区：
文献类型：
--
作者：
Galobardes B;Granell R;Sterne J;Hughes R;Mejia-Lancheros C;Davey Smith G;Henderson J
确定可预防的导致哮喘和相关过敏的暴露已被证明具有挑战性，部分原因是难以区分定义同质疾病组的表型。了解疾病表型的社会经济模式有助于区分哪些暴露是可以预防的。在本研究中，我们确定了易受社会经济变化影响的疾病表型，并确定了当代出生队列中哪些生命过程暴露与这些不平等相关。参与者包括来自Avon父母和儿童纵向研究的儿童，这是一个基于人口的英格兰出生队列，出生于1991年和1992年，7-8岁时参加诊所（n = 6，378）。疾病表型包括哮喘、特应性、喘息、肺功能改变和支气管反应性表型。将特应性与医生对哮喘的诊断相结合，发现了最大的社会经济差异，包括表型组之间的相反模式：社会经济地位低（SEP）的儿童单独患有哮喘的比例更高。（调整后的多项比值比= 1.50，95%置信区间：1.21，1.87），但较少单独的特应性（调整后的多项比值比= 0.80，95%置信区间：0.66,0.98）母亲在怀孕期间暴露于烟草烟雾和儿童暴露于烟草烟雾的调整降低了哮喘的几率目前在患有哮喘但没有特应性的儿童中存在的不平等可以通过消除烟草烟雾的暴露来预防。其他疾病表型没有社会模式或SEP模式与烟雾暴露无关。
Identifying preventable exposures that lead to asthma and associated allergies has proved challenging, partly because of the difficulty in differentiating phenotypes that define homogeneous disease groups. Understanding the socioeconomic patterns of disease phenotypes can help distinguish which exposures are preventable. In the present study, we identified disease phenotypes that are susceptible to socioeconomic variation, and we determined which life-course exposures were associated with these inequalities in a contemporary birth cohort. Participants included children from the Avon Longitudinal Study of Parents and Children, a population-based birth cohort in England, who were born in 1991 and 1992 and attended the clinic at 7–8 years of age (n = 6,378). Disease phenotypes included asthma, atopy, wheezing, altered lung function, and bronchial reactivity phenotypes. Combining atopy with a diagnosis of asthma from a doctor captured the greatest socioeconomic variation, including opposing patterns between phenotype groups: Children with a low socioeconomic position (SEP) had more asthma alone (adjusted multinomial odds ratio = 1.50, 95% confidence interval: 1.21, 1.87) but less atopy alone (adjusted multinomial odds ratio = 0.80, 95% confidence interval: 0.66, 0.98) than did children with high SEP. Adjustment for maternal exposure to tobacco smoke during pregnancy and childhood exposure to tobacco smoke reduced the odds of asthma alone in children with a low SEP. Current inequalities among children who have asthma but not atopy can be prevented by eliminating exposure to tobacco smoke. Other disease phenotypes were not socially patterned or had SEP patterns that were not related to smoke exposure.