社会和环境应激因子在家庭和儿童期哮喘中的作用
2009/12/15
目的：环境因素和慢性应激是增加哮喘易感性的独立因子。然而，我们对上述因素对哮喘的影响了解较少。本试验在脆弱家庭及儿童福利研究（n=2013）的儿童中研究母亲遭受的家庭暴力（IPV）、居住质量与哮喘之间的关系。
方法：于儿童出生及出生后12个月、36个月获取母亲主诉的IPV，在为期36个月的评价中，采访者对家庭室内环境进行评价，包括住房老化（油漆剥落、地板穿孔或窗户破碎）以及居住环境混乱（黑暗、凌乱、拥挤、嘈杂）。同时，记录母亲主诉的住房困难（反复搬家、室内供暖困难）。将第36个月诊断的在过去1年里处于活动期的子女哮喘作为结果。
结果：10％的儿童被诊断为哮喘，校正分析后，与其它组相比，母亲经历长期IPV和儿童期居住环境混乱的儿童哮喘风险增加哮喘风险增加，OR分别为1.8（95% CI 1.0, 3.5）和1.5（95% CI 1.1, 2.0）。分层分析显示，存在居住环境混乱或住房条件老化或母亲经历住房困难的儿童，IPV对哮喘的影响较大。
结论：IPV和居住环境混乱与儿童早期哮喘发病率增加相关。与单因素暴露相比，累积性的或多种应激因素暴露（如IPV和住房质量差）使儿童期发生哮喘的风险增加。
（ 陈 欣 审校）
J Epidemiol Community Health. 2009 Oct 14.
Social and environmental stressors in the home and childhood asthma.
Franco Suglia S, Duarte CS, Sandel MT, Wright RJ.
OBECTIVES: Both physical environmental factors and chronic stress may independently increase susceptibility to asthma; however, little is known on how these different risks may interact. We examined the relationship between maternal intimate partner violence (IPV), housing quality and asthma among children in the Fragile Families and Child Wellbeing Study (N=2013).
METHODS: Maternal reports of IPV were obtained after the child’s birth and at 12 and 36 months. At the 36 month assessment, interviewers rated indoor housing conditions, regarding housing deterioration (i.e., peeling paint, holes in floor, broken windows) and housing disarray (i.e., dark, cluttered, crowded or noisy house). At the same time, mothers reported on housing hardships (i.e., moving repeatedly, and hardships in keeping house warm). Maternal-report of physician-diagnosed asthma by age 36 months which was active in the past year was the outcome.
RESULTS: Asthma was diagnosed in 10% of the children. In adjusted analysis, an increased odds of asthma was observed in children of mothers experiencing IPV chronically (OR 1.8, 95% CI 1.0, 3.5) and in children experiencing housing disarray (OR 1.5, 95% CI 1.1, 2.0) compared to those not exposed to these risks. In stratified analyses, a greater effect of IPV on asthma was noted among children living in disarrayed or deteriorated housing or among children whose mothers were experiencing housing hardship.
CONCLUSIONS: IPV and housing disarray are associated with increased early childhood asthma. Exposure to cumulative or multiple stressors (i.e. IPV and poor housing quality) may increase children’s risk of developing asthma more than a single stressor.
J Epidemiol Community Health. 2009 Oct 14.
方法：于儿童出生及出生后12个月、36个月获取母亲主诉的IPV，在为期36个月的评价中，采访者对家庭室内环境进行评价，包括住房老化（油漆剥落、地板穿孔或窗户破碎）以及居住环境混乱（黑暗、凌乱、拥挤、嘈杂）。同时，记录母亲主诉的住房困难（反复搬家、室内供暖困难）。将第36个月诊断的在过去1年里处于活动期的子女哮喘作为结果。
结果：10％的儿童被诊断为哮喘，校正分析后，与其它组相比，母亲经历长期IPV和儿童期居住环境混乱的儿童哮喘风险增加哮喘风险增加，OR分别为1.8（95% CI 1.0, 3.5）和1.5（95% CI 1.1, 2.0）。分层分析显示，存在居住环境混乱或住房条件老化或母亲经历住房困难的儿童，IPV对哮喘的影响较大。
结论：IPV和居住环境混乱与儿童早期哮喘发病率增加相关。与单因素暴露相比，累积性的或多种应激因素暴露（如IPV和住房质量差）使儿童期发生哮喘的风险增加。
（ 陈 欣 审校）
J Epidemiol Community Health. 2009 Oct 14.
Social and environmental stressors in the home and childhood asthma.
Franco Suglia S, Duarte CS, Sandel MT, Wright RJ.
OBECTIVES: Both physical environmental factors and chronic stress may independently increase susceptibility to asthma; however, little is known on how these different risks may interact. We examined the relationship between maternal intimate partner violence (IPV), housing quality and asthma among children in the Fragile Families and Child Wellbeing Study (N=2013).
METHODS: Maternal reports of IPV were obtained after the child’s birth and at 12 and 36 months. At the 36 month assessment, interviewers rated indoor housing conditions, regarding housing deterioration (i.e., peeling paint, holes in floor, broken windows) and housing disarray (i.e., dark, cluttered, crowded or noisy house). At the same time, mothers reported on housing hardships (i.e., moving repeatedly, and hardships in keeping house warm). Maternal-report of physician-diagnosed asthma by age 36 months which was active in the past year was the outcome.
RESULTS: Asthma was diagnosed in 10% of the children. In adjusted analysis, an increased odds of asthma was observed in children of mothers experiencing IPV chronically (OR 1.8, 95% CI 1.0, 3.5) and in children experiencing housing disarray (OR 1.5, 95% CI 1.1, 2.0) compared to those not exposed to these risks. In stratified analyses, a greater effect of IPV on asthma was noted among children living in disarrayed or deteriorated housing or among children whose mothers were experiencing housing hardship.
CONCLUSIONS: IPV and housing disarray are associated with increased early childhood asthma. Exposure to cumulative or multiple stressors (i.e. IPV and poor housing quality) may increase children’s risk of developing asthma more than a single stressor.
J Epidemiol Community Health. 2009 Oct 14.
上一篇：
在哮喘流行情况及自然史研究中，哮喘控制始终不佳（符合专家小组报告3指南中疾病受损领域）的患者，未来哮
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美国儿童和青少年肥胖与哮喘的关系
