Siblings, day-care attendance, and the risk of asthma and wheezing during childhood
Siblings, day-care attendance, and the risk of asthma and wheezing during childhood
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DOI：
10.1056/nejm200008243430803
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发表时间：
2000-08-24
影响因子：
158.5
通讯作者：
Wright, AL
中科院分区：
文献类型：
--
作者：
Ball, TM;Castro-Rodriguez, JA;Wright, AL
背景资料：有年长兄弟姐妹的幼儿和那些参加日托的幼儿感染的风险增加，这反过来可能会防止过敏性疾病的发展，包括哮喘。然而，研究暴露于其他儿童和随后的哮喘发展之间的关系的结果一直相互矛盾。方法：在一项涉及1035名儿童的研究中，作为图森儿童呼吸研究的一部分，我们确定了哮喘的发病率，（定义为在儿童6至13岁时至少有一次经医生诊断的哮喘发作）和频繁喘息的患病率（在前一年中超过三次喘息发作）与家中兄弟姐妹数量和婴儿期日托出勤率的关系。结果：家中有一个或多个年长的兄弟姐妹可以预防哮喘的发生（每增加一个年长的兄弟姐妹，调整的相对风险为0.8; 95%置信区间为0.7至1.0; P = 0.04），在出生后的前六个月内参加日托也是如此（调整后的相对危险度为0.4; 95%置信区间为0.2至1.0; P = 0.04）。在家中或日托中心与其他儿童接触较多的儿童在2岁时比很少或没有接触的儿童更容易发生频繁喘息（调整后的相对危险度为1.4; 95%可信区间为1.1 ~ 1.8; P = 0.01），但从6岁开始频繁喘息的可能性较低（调整后的相对风险，0.8; 95%置信区间，0.6至1.0; P = 0.03）至13岁（调整后的相对风险，0.3; 95%置信区间，0.2至0.5; P = 0.03）
Background: Young children with older siblings and those who attend day care are at increased risk for infections, which in turn may protect against the development of allergic diseases, including asthma. However, the results of studies examining the relation between exposure to other children and the subsequent development of asthma have been conflicting.Methods: In a study involving 1035 children followed since birth as part of the Tucson Children's Respiratory Study, we determined the incidence of asthma (defined as at least one episode of asthma diagnosed by a physician when the child was 6 to 13 years old) and the prevalence of frequent wheezing (more than three wheezing episodes during the preceding year) in relation to the number of siblings at home and in relation to attendance at day care during infancy.Results: The presence of one or more older siblings at home protected against the development of asthma (adjusted relative risk for each additional older sibling, 0.8; 95 percent confidence interval, 0.7 to 1.0; P = 0.04), as did attendance at day care during the first six months of life (adjusted relative risk, 0.4; 95 percent confidence interval, 0.2 to 1.0; P = 0.04). Children with more exposure to other children at home or at day care were more likely to have frequent wheezing at the age of 2 years than children with little or no exposure (adjusted relative risk, 1.4; 95 percent confidence interval, 1.1 to 1.8; P = 0.01) but were less likely to have frequent wheezing from the age of 6 (adjusted relative risk, 0.8; 95 percent confidence interval, 0.6 to 1.0; P = 0.03) through the age of 13 (adjusted relative risk, 0.3; 95 percent confidence interval, 0.2 to 0.5; P