Abstract
The International Study of Asthma and Allergies in Childhood (ISAAC) Phase One showed large worldwide variations in the prevalence of symptoms of asthma, rhinoconjunctivitis and eczema, up to 10 to 20 fold between countries. Ecological analyses were undertaken with ISAAC Phase One data to explore factors that may have contributed to these variations, and are summarised and reviewed here. In ISAAC Phase One the prevalence of symptoms in the past 12 months of asthma, rhinoconjunctivitis and eczema were estimated from studies in 463,801 children aged 13 - 14 years in 155 centres in 56 countries, and in 257,800 children aged 6-7 years in 91 centres in 38 countries. Ecological analyses were undertaken between symptom prevalence and the following: Gross National Product per capita (GNP), food intake, immunisation rates, tuberculosis notifications, climatic factors, tobacco consumption, pollen, antibiotic sales, paracetamol sales, and outdoor air pollution.Symptom prevalence of all three conditions was positively associated with GNP, trans fatty acids, paracetamol, and women smoking, and inversely associated with food of plant origin, pollen, immunisations, tuberculosis notifications, air pollution, and men smoking. The magnitude of these associations was small, but consistent in direction between conditions. There were mixed associations of climate and antibiotic sales with symptom prevalence.The potential causality of these associations warrant further investigation. Factors which prevent the development of these conditions, or where there is an absence of a positive correlation at a population level may be as important from the policy viewpoint as a focus on the positive risk factors. Interventions based on small associations may have the potential for a large public health benefit.
Original language | English (US) |
---|---|
Article number | 8 |
Journal | Respiratory Research |
Volume | 11 |
DOIs | |
State | Published - Jan 21 2010 |
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
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In: Respiratory Research, Vol. 11, 8, 21.01.2010.
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TY - JOUR
T1 - Which population level environmental factors are associated with asthma, rhinoconjunctivitis and eczema? Review of the ecological analyses of ISAAC Phase One
AU - Innes Asher, M.
AU - Stewart, Alistair W.
AU - Mallol, Javier
AU - Montefort, Stephen
AU - Lai, Christopher K.W.
AU - Aït-Khaled, Nadia
AU - Odhiambo, Joseph
AU - Anabwani, G.
AU - Anderson, H. R.
AU - Clayton, T. O.
AU - Ellwood, P.
AU - Mitchell, E. A.
AU - Beasley, R.
AU - Björkstén, B.
AU - Burr, M. L.
AU - Crane, J.
AU - Keil, U.
AU - Martinez, F.
AU - Pearce, N.
AU - Robertson, C. F.
AU - Shah, J. R.
AU - Sibbald, B.
AU - Strachan, D. P.
AU - von Mutius, E.
AU - Weiland, S. K.
AU - Williams, H. C.
AU - Bezzaoucha, A.
AU - Melaku, K.
AU - Seyoum, B.
AU - Esamai, F. O.
AU - Onadeko, B. O.
AU - Nelson, H.
AU - Chen, Y. Z.
AU - Chen, K. H.
AU - Zhong, N. S.
AU - Bao-Shan, M.
AU - Xiao, M. L.
AU - Lau, Y. L.
AU - Baratawidjaja, K.
AU - Nishima, S.
AU - Teh, K. H.
AU - Yeong, L. W.
AU - de Bruyne, J.
AU - Quah, B. S.
AU - Chum, K. W.
AU - Cua-Lim, F.
AU - Lee, S. I.
AU - Lee, B. W.
AU - Hsieh, K. H.
AU - Vichyanond, P.
AU - Trakultivakorn, M.
AU - Masjedi, M. R.
AU - al-Momen, J. A.
AU - Ramadan, F. M.
AU - Al Riyami, B. M.S.
AU - Bouayad, Z.
AU - Bennis, A.
AU - Bhutta, Z. A.
AU - Salmun, N.
AU - Rosário, N.
AU - Stein, R.
AU - Bezerra, P. G.M.
AU - deFreitas Souza, L.
AU - Solé, D.
AU - Sanchez, I.
AU - Amarales, L.
AU - Cortez, E.
AU - Calvo, M. A.
AU - Soto-Quirós, C.
AU - Romieu, I.
AU - Cukier, G.
AU - Guggiari-Chase, J. A.
AU - Chiarella, P.
AU - Holgado, D.
AU - Sears, M. R.
AU - Taylor, B.
AU - Persky, V.
AU - Redding, G. J.
AU - Jeffs, D.
AU - Grainger, C. R.
AU - Priftanji, A.
AU - Riikjärv, M. A.
AU - Kajosaari, M.
AU - Pekkanen, J.
AU - Soininen, L.
AU - Koivikko, T. A.
AU - Khetsuriani, N.
AU - Gamkrelidze, A.
AU - Leja, M.
AU - Lis, G.
AU - Brêborowicz, A.
AU - Dumitrascu, D.
AU - Khaitov, R. M.
AU - Kjellman, N. I.
AU - Foucard, T.
AU - Aripova, T.
AU - Kennedy, D.
AU - Landau, L.
AU - Peat, J.
AU - Bauman, A.
AU - Moyes, C.
AU - Pattemore, P.
AU - Barry, D.
AU - Mackay, R.
AU - Maheshwari, R. M.
AU - Joshi, M. K.
AU - Pai, U. A.
AU - Raghavan, K.
AU - Khatav, V. A.
AU - Kumar, L.
AU - Jain, K. C.
AU - Sukumaran, T. U.
AU - Rajajee, S.
AU - Somu, N.
AU - Chopra, K.
AU - Jayaraj, G.
AU - Kar, P. K.
AU - Hanumante, N. M.
AU - Riedler, J.
AU - Haidinger, G.
AU - Vermeire, P.
AU - Charpin, D.
AU - Godard, P.
AU - Taytard, A.
AU - Kopferschmitt, C.
AU - Annesi-Maesano, I.
AU - Kramer, A.
AU - Gratziou, C.
AU - Powell, P. V.
AU - Bonini, S.
AU - Bonci, E.
AU - Rusconi, F.
AU - Biocca, M.
AU - Chetoni, L.
AU - Chellini, E.
AU - Ronchetti, R.
AU - Bisanti, L.
AU - Forastiere, F.
AU - Renzoni, E.
AU - Ciccone, G.
AU - Piffer, S.
AU - Boner, A.
AU - Corbo, G.
AU - Borges, F. D.
AU - Rosado Pinto, J. E.
AU - Nunes, C.
AU - Lopesdos Santos, J. M.
AU - Clancy, L.
AU - Busquets, R. M.
AU - Rubio, A. D.
AU - Asensio, A. R.
AU - García-Marcos, L.
AU - Arnedo-Pena, A.
AU - Guillén-Grima, F.
AU - Morales-Suárez-Varela, M. M.
AU - Blanco Quirós, A.
AU - Shamssain, M. H.
AU - Strachan, D.
N1 - Funding Information: The authors are indebted to the collaborators in the participating centres and all parents, children, teachers and other school staff who participated in the surveys. There are many field workers and funding agencies who supported data collection and national, regional and international meetings, including the meetings of the ISAAC Steering Committee. Unfortunately, these are too numerous to mention (they are acknowledged elsewhere) but the authors particularly wish to thank the funders who supported the ISAAC International Data Centre including the Health Research Council of New Zealand, the Asthma and Respiratory Foundation of New Zealand, the National Child Health Research Foundation, the Hawke’s Bay Medical Research Foundation, the Waikato Medical Research Foundation, Glaxo Wellcome New Zealand and Astra New Zealand, as well as Glaxo Wellcome International Medical Affairs for finding the regional coordinating centres. The International Data Centre is now supported by a grant from the BUPA Foundation. ISAAC Phase One study group ISAAC Steering Committee: N Aït-Khaled (Union Internationale Contre la Tuberculose et les Maladies Respiratoires, Paris, France); G Anabwani (Princess Marina Hospital, Gaborone, Botswana); HR Anderson (St Georges, University of London and MRC Centre for Environment and Health, London, UK); MI Asher (Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand); R Beasley (Medical Research Institute of New Zealand, Wellington, New Zealand); B Björkstén (National Institute of Environmental Medicine/IMM, Karolinska Institutet, Stockholm, Sweden); ML Burr (Department of Primary Care & Public Health, Cardiff University Neuadd Meirionnydd, Cardiff, UK); J Crane (Wellington Asthma Research Group, Wellington School of Medicine, New Zealand); U Keil (Institut für Epidemiologie und Sozialmedizin, Westfälische Wilhelms Universität, Münster, Germany); CKW Lai (Department of Medicine and Therapeutics, The Chinese University of Hong Kong, SAR China); J Mallol (Department of Pediatric Respiratory Medicine, University of Santiago de Chile, Chile); F Martinez (Arizona Respiratory Center, University of Arizona, Tucson, Arizona, USA); EA Mitchell (Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand); S Montefort (Department of Medicine, University of Malta, Malta); N Pearce (Centre for Public Health Research, Massey University, Wellington, New Zealand); CF Robertson (Murdoch Children’s Research Institute, Melbourne, Australia); JR Shah (Jaslok Hospital & Research Centre, Mumbai, India); B Sibbald, (University of Manchester, Manchester, UK); AW Stewart (Population Health, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand); DP Strachan (Division of Community Health Sciences, St Georges Hospital Medical School, London, UK); E von Mutius (Dr von Haunerschen Kinderklinik de Universität München, Germany); SK Weiland* (Department of Epidemiology, University of Ulm, Germany); HC Williams (Centre for Evidence Based Dermatology, Nottingham University Hospital’s Queen’s Medical Centre, Nottingham, UK). *Deceased ISAAC International Data Centre: MI Asher, TO Clayton, P Ellwood, EA Mitchell, (Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand); AW Stewart, (School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand). ISAAC Phase One Principal Investigators: Africa Algeria: A Bezzaoucha (Algiers); Ethiopia: K Melaku* (Addis Ababa), B Seyoum (Jima); Kenya: FO Esamai (Eldoret), JA Odhiambo* (Nairobi); Nigeria: BO Onadeko (Ibadan); South Africa: H Nelson (Cape Town); Asia Pacific China: Y-Z Chen* (Beijing), K-H Chen (Chongqing), N-S Zhong (Guangzhou), M Bao-Shan (Shanghai), M-L Xiao (Wulumuqi); Hong Kong: C Lai* (Hong Kong 13-14 yr), YL Lau (Hong Kong 6-7 yr); Indonesia: Dr K Baratawidjaja* (Bandung); Japan: S Nishima (Fukuoka); Malaysia: KH Teh (Alor Setar), LW Yeong (Ipoh), J de Bruyne* (Klang Valley), BS Quah (Kota Bharu), KW Chum (Muar); Philippines: F Cua-Lim (Metro Manilla); South Korea: S-I Lee* (Provincial Korea and Seoul); Singapore: B-W Lee (Singapore); Taiwan: K-H Hsieh* (deceased) (Taipei); Thailand: P Vichyanond* (Bangkok), M Trakultivakorn (Chiang Mai); Eastern Mediterranean Iran: M-R Masjedi* (Rasht and Tehran); Kuwait: JA al-Momen (Kuwait); Lebanon: FM Ramadan (Beirut); Oman: BMS Al Riyami (Al-Khod); Malta: S Montefort (Malta); Morocco: Z Bouayad* (Casablanca and Marrakech), A Bennis (Rabat); Pakistan: ZA Bhutta (Karachi); Latin America Argentina: N Salmun* (Buenos Aires and Rosario); Brazil: N Rosário (Curitiba), R Stein (Porto Alegre), PGM Bezerra (Recife), L de Freitas Souza (Salvador), D Solé* (Sao Paulo); Chile: I Sanchez (Central Santiago), L Amarales (Punta Arenas), E Cortez (South Santiago), MA Calvo (Valdivia); Costa Rica (ME Soto-Quirós), Mexico: I Romieu (Cuernavaca); Panama: G Cukier (David-Panama); Paraguay: JA Guggiari-Chase (Asuncion); Peru: P Chiarella (Lima); Uruguay: D Holgado (Montevideo); North America Canada: MR Sears* (Hamilton), B Taylor (Saskatoon); USA: V Persky (Chicago [3]), GJ Redding (Seattle); Northern and Eastern Europe Albania: A Priftanji (Tirane); Estonia: M-A Riikjärv* (Narva and Tallinn); Finland: M Kajosaari (Helsinki), J Pekkanen* (Kuopio County), L Soininen (Lapland Area), TA Koivikko (Turku and Pori County); Georgia: N Khetsuriani (Kutaisi), A Gamkrelidze* (Tbilisi); Latvia: M Leja* (Riga and Rural Latvia); Poland: G Lis* (Krakow), A Brêborowicz (Poznan); Romania: D Dumitrascu (Cluj); Russia: RM Khaitov (Moscow); Sweden: N-I Kjellman (Linköping), T Foucard (Stockholm/Uppsala); Uzbekistan: T Aripova* (Samarkand and Tashkent); Oceania Australia: D Kennedy (Adelaide), CF Robertson* (Melbourne), L Landau (Perth), J Peat (Sydney 6-7 yr), A Bauman (Sydney 13-14 yr); New Zealand: MI Asher* (Auckland), C Moyes (Bay of Plenty), P Pattemore (Christchurch), D Barry (Hawke’s Bay), R Mackay (Nelson), J Crane (Wellington); Indian Subcontinent India: RM Maheshwari (Akola), MK Joshi (Bombay [16]), UA Pai (Bombay [17]), K Raghavan (Bombay [18]), VA Khatav (Borivali), L Kumar (Chandigarh), KC Jain (Jodhpur), TU Sukumaran (Kottayam), S Rajajee (Madras [2]), N Somu (Madras [3]), K Chopra (New Delhi [7]), G Jayaraj (Neyveli), PK Kar (Orissa), NM Hanumante (Pune); Western Europe Austria: J Riedler* (Salzburg), G Haidinger (Urfahr-Umgebung); Belgium: P Vermeire (Antwerp); Channel Islands: D Jeffs (Guernsey), CR Grainger (Jersey), France: D Charpin* (Marseilles), P Godard (Montpellier), A Taytard (Pessac), C Kopferschmitt (Strasbourg), I Annesi-Maesano (West Marne); Germany: A Kramer (Greifswald), U Keil* (Munster); Greece: C Gratziou (Athens); Isle of Man (PV Powell), Italy: S Bonini (Ascoli Piceno), E Bonci (Cosenza), F Rusconi (Cremona), M Biocca (Emilia-Romagna), L Chetoni (Empoli), E Chellini (Firenze), R Ronchetti (Frosinone), L Bisanti (Milano), F Forastiere* (Roma), E Renzoni (Siena), G Ciccone (Torino), S Piffer (Trento), A Boner (Verona), G Corbo (Viterbo); Portugal: FD Borges (Funchal), JE Rosado Pinto* (Lisbon), C Nunes (Portimão), JM Lopes dos Santos (Porto); Republic of Ireland: L Clancy (Rep of Ireland); Spain: RM Busquets (Barcelona), AD Rubio (Bilbao), AR Asensio (Cadiz), L García-Marcos* (Cartagena), A Arnedo-Pena (Castellon), F Guillén-Grima (Pamplona), MM Morales-Suárez-Varela (Valencia), A Blanco Quirós (Valladolid); United Kingdom: HR Anderson* (Anglia and Oxford, North East and Yorkshire, North Thames, North West, South and West, South Thames, Scotland, Trent, Wales, West Midlands), MH Shamssain (Sunderland), D Strachan (Surrey/Sussex). *National Coordinator National Coordinators not identified above Chile: J Mallol; India: J Shah 1Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand. 2School of Population Health, The University of Auckland, Auckland, New Zealand. 3Department of Pediatric Respiratory Medicine, University of Santiago de Chile (USACH), Hospital El Pino, Santiago, Chile. 4Department of Medicine, University of Malta, Malta. 5Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR PR China. 6International Union Against Tuberculosis Lung Diseases, Paris, France. 7Centre for Respiratory Diseases Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya. 8Members listed at the end of the manuscript.
PY - 2010/1/21
Y1 - 2010/1/21
N2 - The International Study of Asthma and Allergies in Childhood (ISAAC) Phase One showed large worldwide variations in the prevalence of symptoms of asthma, rhinoconjunctivitis and eczema, up to 10 to 20 fold between countries. Ecological analyses were undertaken with ISAAC Phase One data to explore factors that may have contributed to these variations, and are summarised and reviewed here. In ISAAC Phase One the prevalence of symptoms in the past 12 months of asthma, rhinoconjunctivitis and eczema were estimated from studies in 463,801 children aged 13 - 14 years in 155 centres in 56 countries, and in 257,800 children aged 6-7 years in 91 centres in 38 countries. Ecological analyses were undertaken between symptom prevalence and the following: Gross National Product per capita (GNP), food intake, immunisation rates, tuberculosis notifications, climatic factors, tobacco consumption, pollen, antibiotic sales, paracetamol sales, and outdoor air pollution.Symptom prevalence of all three conditions was positively associated with GNP, trans fatty acids, paracetamol, and women smoking, and inversely associated with food of plant origin, pollen, immunisations, tuberculosis notifications, air pollution, and men smoking. The magnitude of these associations was small, but consistent in direction between conditions. There were mixed associations of climate and antibiotic sales with symptom prevalence.The potential causality of these associations warrant further investigation. Factors which prevent the development of these conditions, or where there is an absence of a positive correlation at a population level may be as important from the policy viewpoint as a focus on the positive risk factors. Interventions based on small associations may have the potential for a large public health benefit.
AB - The International Study of Asthma and Allergies in Childhood (ISAAC) Phase One showed large worldwide variations in the prevalence of symptoms of asthma, rhinoconjunctivitis and eczema, up to 10 to 20 fold between countries. Ecological analyses were undertaken with ISAAC Phase One data to explore factors that may have contributed to these variations, and are summarised and reviewed here. In ISAAC Phase One the prevalence of symptoms in the past 12 months of asthma, rhinoconjunctivitis and eczema were estimated from studies in 463,801 children aged 13 - 14 years in 155 centres in 56 countries, and in 257,800 children aged 6-7 years in 91 centres in 38 countries. Ecological analyses were undertaken between symptom prevalence and the following: Gross National Product per capita (GNP), food intake, immunisation rates, tuberculosis notifications, climatic factors, tobacco consumption, pollen, antibiotic sales, paracetamol sales, and outdoor air pollution.Symptom prevalence of all three conditions was positively associated with GNP, trans fatty acids, paracetamol, and women smoking, and inversely associated with food of plant origin, pollen, immunisations, tuberculosis notifications, air pollution, and men smoking. The magnitude of these associations was small, but consistent in direction between conditions. There were mixed associations of climate and antibiotic sales with symptom prevalence.The potential causality of these associations warrant further investigation. Factors which prevent the development of these conditions, or where there is an absence of a positive correlation at a population level may be as important from the policy viewpoint as a focus on the positive risk factors. Interventions based on small associations may have the potential for a large public health benefit.
UR - http://www.scopus.com/inward/record.url?scp=77952484434&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77952484434&partnerID=8YFLogxK
U2 - 10.1186/1465-9921-11-8
DO - 10.1186/1465-9921-11-8
M3 - Review article
C2 - 20092649
SN - 1465-9921
VL - 11
JO - Respiratory Research
JF - Respiratory Research
M1 - 8
ER -