Tobacco smoke exposure and socioeconomic factors are independent predictors of pulmonary decline in pediatric cystic fibrosis
Tobacco smoke exposure and socioeconomic factors are independent predictors of pulmonary decline in pediatric cystic fibrosis
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DOI：
10.1016/j.jcf.2020.02.004
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发表时间：
2020-09-01
影响因子：
5.2
通讯作者：
Harris, William T.
中科院分区：
文献类型：
--
作者：
Oates, Gabriela R.;Baker, Elizabeth;Harris, William T.
背景：CF的肺功能下降是异质性的，社会环境因素导致了这种变异性。很少有研究试图解开烟草烟雾暴露和社会经济因素对儿童CF肺功能恶化的影响。目前的研究评估他们的贡献纵向整个美国CF护理网络population.Methods：数据从CF基金会患者登记处获得的所有个人谁在2016年底是6-18岁。在每个达到的年龄计算每个人的肺功能测量值（ppFEV（1））。多变量分析采用混合建模来评估烟雾暴露和社会经济因素对初始肺功能的影响，并随时间推移而变化。结果：样本包括10,895人，贡献65,581人年。在6岁时，暴露于烟雾的儿童的ppFEV（1）比未暴露的儿童低4.7%。这种缺陷一直持续到18岁。在调整后的混合模型中，烟雾暴露和社会经济因素与肺功能有独立的、累加的关联。中位ppFEV（1）随吸烟暴露下降2.4%，随父亲教育程度降低下降4.9%，随公共保险下降0.3%，随家庭年收入每增加10，000美元增加0.2%。吸烟暴露对弱势儿童ppFEV（1）的影响大于特权儿童（3.2%vs1.2%.Conclusions：吸烟暴露和社会经济因素是儿童CF中ppFEV（1）降低的独立危险因素。在CF诊断时应强调戒烟策略，并在婴儿期和幼儿期重申。干预措施可优先用于处境不利的家庭，因为在这些家庭中，接触艾滋病毒的影响特别大。(C)2020年欧洲囊性纤维化协会。Elsevier B. V.出版，保留所有权利。
Background: Pulmonary decline in CF is heterogeneous, with socio-environmental factors contributing to this variability. Few studies have attempted to disentangle the effects of tobacco smoke exposure and socioeconomic factors on lung function deterioration in pediatric CF. The current study evaluates their contributions longitudinally across the entire U.S. CF care network population.Methods: Data from the CF Foundation Patient Registry were obtained on all individuals who at the end of 2016 were 6-18 years old. Lung function measures (ppFEV(1)) for each person were calculated at each attained age. Multivariable analyses used mixed modeling to assess the impact of smoke exposure and socioeconomic factors on initial lung function and change over time.Results: The sample included 10,895 individuals contributing 65,581 person years. At age 6, ppFEV(1) of smoke-exposed children was 4.7% lower than among unexposed. The deficit persisted through age 18. In adjusted mixed models, smoke exposure and socioeconomic factors had independent, additive associations with lung function. Median ppFEV(1 )declined 2.4% with smoke exposure, 4.9% with lower paternal education, 0.3% with public insurance, and increased 0.2% with each $10,000 annual household income. The effect of smoke exposure on ppFEV(1) was larger in disadvantaged children compared to privileged counterparts (3.2% vs 1.2%).Conclusions: Smoke exposure and socioeconomic factors are independent risk factors for decreased ppFEV(1) in pediatric CF. Smoking cessation strategies should be emphasized at the time of CF diagnosis and reiterated during infancy and early childhood. Interventions may be prioritized in disadvantaged families, where the exposure has a disproportionately large effect. (C) 2020 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.