海拔1500米以上，是 哮喘发病率的主要决定因素，一项生态学研究
2018/05/30
摘要
背景：先前的研究表明哮喘与海拔呈负相关。在目前的工作中，我们在墨西哥758县包括全国最大的医疗机构对哮喘发病率进行了深入的分析（∼3750万参保对象），评估哮喘与海拔高度及其他危险因素的相关性。
方法:根据家庭医生诊断的新病例，计算每个县的哮喘发病率。其他变量，包括选定的疾病，地理变量和社会经济因素，通过双变量和多变量分析也获得了他们与哮喘的相关性。
结果:参保对象哮喘的发病率中位数为296.2 × 100000，且往往那些位于或靠近海岸县的发病率更高。当哮喘发生率与海拔高度一致时，一个两阶段模式非常明显：哮喘发病率于海拔低于1500 米的县相对稳定，而随着海拔高度的增加并超过1500米水平时，哮喘发病率逐步下降（RS = -0.51，P＜0.001）。多因素分析显示，每一个变量均被别的潜在影响因素进行调整，哮喘的发病率与海拔高度（标准化β系数，0.577）、蠕虫（0.173），肺结核（0.130）、纬度（- 0.126）呈负相关，与急性呼吸道感染（0.382），肺炎（0.289），2型糖尿病（0.138）、人口（0.108），和咽扁桃体炎（0.088）呈正相关，所有P ≤ 0.001。
结论：我们的研究表明，海拔高于1500米为确定哮喘发病的主要因素，且随着海拔高度的增加新发哮喘的风险降低。其他影响较小的条件也被确定。
Altitude above 1500 m is a major determinant of asthma incidence. An ecological study.
Vargas MH, Becerril-Ángeles M,
Abstract
BACKGROUND: Previous studies suggest an inverse correlation between asthma and altitude. In the present work, we performed an in-depth analysis of asthma incidence in the 758 Mexican counties covered by the largest medical institution in the country (∼37.5 million insured subjects), and evaluated its relationships with altitude and other factors.
METHODS: Asthma incidence in each county was calculated from new cases diagnosed by family physicians. Other variables in the same counties, including selected diseases, geographical variables, and socioeconomic factors, were also obtained and their association with asthma was evaluated through bivariate and multivariate analyses.
RESULTS: Median asthma incidence was 296.2 × 100,000 insured subjects, but tended to be higher in those counties located on or near the coast. When asthma incidence was plotted against altitude, a two-stage pattern was evident: asthma rates were relatively stable in counties located below an altitude of ∼1500 m, while these rates progressively decreased as altitude increased beyond this level (rS = -0.51, p < .001). Multivariate analysis showed that, once each variable was adjusted by the potential influence of the others, asthma incidence was inversely correlated with altitude (standardized β coefficient, -0.577), helminthiasis (-0.173), pulmonary tuberculosis (-0.130), and latitude (-0.126), and was positively correlated with acute respiratory tract infection (0.382), pneumonia (0.289), type 2 diabetes (0.138), population (0.108), and pharyngotonsillitis (0.088), all with a p ≤ .001.
CONCLUSION: Our study showed that altitude higher than ∼1500 m comprises a major factor in determining asthma incidence, with the risk of new-onset asthma decreasing as altitude increases. Other less influential conditions were also identified.
背景：先前的研究表明哮喘与海拔呈负相关。在目前的工作中，我们在墨西哥758县包括全国最大的医疗机构对哮喘发病率进行了深入的分析（∼3750万参保对象），评估哮喘与海拔高度及其他危险因素的相关性。
方法:根据家庭医生诊断的新病例，计算每个县的哮喘发病率。其他变量，包括选定的疾病，地理变量和社会经济因素，通过双变量和多变量分析也获得了他们与哮喘的相关性。
结果:参保对象哮喘的发病率中位数为296.2 × 100000，且往往那些位于或靠近海岸县的发病率更高。当哮喘发生率与海拔高度一致时，一个两阶段模式非常明显：哮喘发病率于海拔低于1500 米的县相对稳定，而随着海拔高度的增加并超过1500米水平时，哮喘发病率逐步下降（RS = -0.51，P＜0.001）。多因素分析显示，每一个变量均被别的潜在影响因素进行调整，哮喘的发病率与海拔高度（标准化β系数，0.577）、蠕虫（0.173），肺结核（0.130）、纬度（- 0.126）呈负相关，与急性呼吸道感染（0.382），肺炎（0.289），2型糖尿病（0.138）、人口（0.108），和咽扁桃体炎（0.088）呈正相关，所有P ≤ 0.001。
结论：我们的研究表明，海拔高于1500米为确定哮喘发病的主要因素，且随着海拔高度的增加新发哮喘的风险降低。其他影响较小的条件也被确定。
(中日友好医院医院呼吸与危重症学科 李红雯 摘译 林江涛 审校)
(Respir Med. 2018 Feb;135:1-7. doi: 10.1016/j.rmed.2017.12.010. Epub 2017 Dec 19.)
(Respir Med. 2018 Feb;135:1-7. doi: 10.1016/j.rmed.2017.12.010. Epub 2017 Dec 19.)
Altitude above 1500 m is a major determinant of asthma incidence. An ecological study.
Vargas MH, Becerril-Ángeles M,
Abstract
BACKGROUND: Previous studies suggest an inverse correlation between asthma and altitude. In the present work, we performed an in-depth analysis of asthma incidence in the 758 Mexican counties covered by the largest medical institution in the country (∼37.5 million insured subjects), and evaluated its relationships with altitude and other factors.
METHODS: Asthma incidence in each county was calculated from new cases diagnosed by family physicians. Other variables in the same counties, including selected diseases, geographical variables, and socioeconomic factors, were also obtained and their association with asthma was evaluated through bivariate and multivariate analyses.
RESULTS: Median asthma incidence was 296.2 × 100,000 insured subjects, but tended to be higher in those counties located on or near the coast. When asthma incidence was plotted against altitude, a two-stage pattern was evident: asthma rates were relatively stable in counties located below an altitude of ∼1500 m, while these rates progressively decreased as altitude increased beyond this level (rS = -0.51, p < .001). Multivariate analysis showed that, once each variable was adjusted by the potential influence of the others, asthma incidence was inversely correlated with altitude (standardized β coefficient, -0.577), helminthiasis (-0.173), pulmonary tuberculosis (-0.130), and latitude (-0.126), and was positively correlated with acute respiratory tract infection (0.382), pneumonia (0.289), type 2 diabetes (0.138), population (0.108), and pharyngotonsillitis (0.088), all with a p ≤ .001.
CONCLUSION: Our study showed that altitude higher than ∼1500 m comprises a major factor in determining asthma incidence, with the risk of new-onset asthma decreasing as altitude increases. Other less influential conditions were also identified.
