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带来了相当大的负担。哮喘和湿疹的患病率在国际上差异很大，分别为20倍至60倍。在许多国家，这种疾病的发生频率仍在增加。流行率很可能与普遍的生活条件有关，这种生活条件在全世界范围内都在迅速变化。“西方生活方式”的影响和相关的个人危险因素在文献中进行了深入的讨论。然而，我们仍远未了解所观察到的变化，因此也远未了解疾病发生的驱动风险因素。我们不再继续只关注个别风险因素的作用，而是提出了一种更加全面和包容的方法，例如，还考虑到风险因素的影响在不同的环境或文化背景下可能会有很大的不同。通过在全球22个国家的30个中心采用统一方法收集的风险因素信息和客观标志物，儿童哮喘和过敏症国际研究（ISAAC）的第二阶段处于独特的地位，可以调查国际差异及其决定因素。先进的统计方法，特别是多层次建模，将用于确定个人和背景风险因素的贡献。确定有影响力的决定因素将为制定有效的预防策略提供宝贵的指导，以防止世界范围内哮喘和过敏的进一步上升，甚至可能扭转当今高患病率国家之前的上升趋势。

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.