Childhood adversity and asthma prevalence: evidence from 10 US states (2009-2011).
Childhood adversity and asthma prevalence: evidence from 10 US states (2009-2011).
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DOI：
10.1136/bmjresp-2013-000016
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发表时间：
2014
影响因子：
4.1
通讯作者：
Subramanian SV
中科院分区：
文献类型：
--
作者：
Bhan N;Glymour MM;Kawachi I;Subramanian SV
关于压力和哮喘患病率的现有证据过分关注怀孕和怀孕后早期生活的压力源，很大程度上忽视了童年逆境作为危险因素的作用。童年逆境（忽视、生活压力大和虐待）可能通过下丘脑-垂体轴机制影响哮喘患病率。来自疾病控制中心 (CDC) 行为危险因素监测系统 (BRFSS) 调查的数据用于检查不良童年经历 (ACE) 与一生和当前哮喘患病率的横断面关联。美国 10 个州的 84 786 名成年受访者提供了有关童年逆境的信息。泊松回归模型（具有稳健的 SE）用于估计将整体 ACE 评分和 ACE 暴露维度与哮喘患病率相关的患病率 (PR)，并根据社会经济状况进行调整。较高的 ACE 与较高的哮喘患病率相关（调整后的 PRcat 4=1.78（95% CI 1.69 至 1.87），调整后的 PRcat 1=1.21（95% CI 1.16 至 1.27））。报告的性虐待经历（调整后的 PR=1.48*（1.42 至 1.55））和身体虐待（调整后的 PR=1.38*（1.33 至 1.43））与较高的哮喘患病率相关。没有发现明显的社会经济梯度，但那些报告教育和收入水平最低的人报告哮喘和逆境的发生率很高。敏感性分析表明 ACE 暴露是相互关联的。童年逆境报告预测美国成年人哮喘患病率。哮喘预防框架需要认识并整合与童年逆境相关的各个方面。对特定暴露时间段的进一步调查将为干预措施提供有意义的推论。
Existing evidence on stress and asthma prevalence has disproportionately focused on pregnancy and postpregnancy early life stressors, largely ignoring the role of childhood adversity as a risk factor. Childhood adversity (neglect, stressful living conditions and maltreatment) may influence asthma prevalence through mechanisms on the hypothalamic-pituitary axis. Data from the Center for Disease Control's (CDC's) Behavioral Risk Factor Surveillance System (BRFSS) surveys were used to examine cross-sectional associations of adverse childhood experiences (ACE) with lifetime and current asthma prevalence. Information on childhood adversity was available from 84 786 adult respondents in 10 US states. Poisson regression models (with robust SE) were used to estimate prevalence ratios (PRs) relating overall ACE score and dimensions of exposure ACE to asthma prevalence, adjusting for socioeconomic status. Greater ACE was associated with a higher prevalence of asthma (adjusted PRcat 4=1.78 (95% CI 1.69 to 1.87), adjusted PRcat 1=1.21 (95% CI 1.16 to 1.27)). Reported experiences of sexual abuse (adjusted PR=1.48* (1.42 to 1.55)) and physical abuse (adjusted PR=1.38* (1.33 to 1.43)) were associated with a higher asthma prevalence. No clear socioeconomic gradient was noted, but those reporting lowest education and income levels reported high rates of asthma and adversity. Sensitivity analyses indicated that ACE exposures were interrelated. Report of childhood adversity predicts asthma prevalence among US adults. Frameworks for asthma prevention need to recognise and integrate aspects related to childhood adversity. Further investigation into specific time periods of exposure would provide meaningful inferences for interventions.