Determinants of international variation in asthma and allergies in childhood: a multilevel approach

哮喘和过敏给儿童及其家庭造成了相当大的负担。在国际上，哮喘和湿疹的患病率差别很大，分别从20倍到60倍不等。在许多国家，该病的发病率仍在增加。发病率很可能与世界范围内正在迅速变化的普遍生活条件有关。“西方生活方式”的影响和相关的个人危险因素在文献中得到了深入的讨论。然而，我们仍然远远不能理解观察到的变化，因此导致疾病发生的危险因素。与其继续只关注个别风险因素的作用，我们建议采用一种更全面、更全面的方法，例如也考虑到风险因素的影响在不同的环境或文化背景下可能有很大差异。通过在全球22个国家的30个中心以统一的方法收集风险因素信息和客观标记，国际儿童哮喘和过敏研究（ISAAC）的第二阶段是调查国际差异及其决定因素的独特场所。先进的统计方法，特别是多层模型将用于确定个人和环境风险因素的贡献。确定有影响的决定因素将为制定有效的预防战略提供宝贵的指导，以防止全世界哮喘和过敏的进一步增加，甚至可能扭转目前高流行国家以前的上升趋势。

Asthma and allergies pose a considerable burden on children and their families. The prevalence varies widely internationally from 20-fold to 60-fold for asthma and eczema, respectively. In many countries the disease frequency is still increasing. Prevalence is most likely linked to the prevailing living conditions which are subject to rapid change world wide. The influence of “western life style” and related individual risk factors is intensively discussed in the literature. However, we are still far from understanding the observed variation, and therefore the driving risk factors for disease occurrence. Instead of continuing to focus only on the role of individual risk factors we propose a more holistic and encompassing approach taking e.g. also into account that the influence of risk factors may vary considerably in different environmental or cultural settings. With risk factor information and objective markers collected with uniform methods in 30 centres from 22 countries worldwide, Phase Two of The International Study of Asthma and Allergies in Childhood (ISAAC) is uniquely placed to investigate international variation and their determinants. Advanced statistical approaches, in particular multilevel modelling will be used to determine the contribution of individual and contextual risk factors. Identification of influential determinants will provide invaluable guidance to develop effective prevention strategies to prevent any further rise in asthma and allergies world wide and may be even to reverse previous rises in nowadays high prevalence countries.