哮喘联盟

   摘要
   目的：旨在评估交通相关空气污染（TRAP）暴露和哮喘或支气管舒张剂治疗反应的喘息再入院的关系
   研究设计：一项基于人群的队列研究，共纳入12个月内再入院的758例1-16岁的儿童哮喘或支气管扩张剂敏感型喘息患者。在入院时使用家庭地址回归模型评估TRAP暴露，且在样品中位数中平分TRAP（0.37 μg/m3）。协变量包括过敏原特异性IgE，香烟烟雾暴露和纳入时获得的社会因素。使用逻辑回归模型和Cox比例风险模型评估TRAP暴露和再入院之间的关系。
   结果：该队列研究中58%是非裔美国人，32%是白种人，19%是首次入院后12个月再次入院的患者。更高的TRAP暴露与更高的再入院率相关（21% vs 16%；P = .05）。调整协变量后这种关系无统计学意义（aOR，1.4；95% CI，0.9-2.）。调整人种的关联，白种儿童高TRAP暴露与低TRAP暴露相比，哮喘再入院率高3倍（OR，3.0；95% CI，1.1-8.1）。非裔美国儿童中，TRAP暴露与增加的再入院无关（OR，1.1； 95% CI， 0.6-1.8）。高TRAP暴露的儿童，白种儿童（危险比， 3.2； 95% CI，1.5-6.7）与非裔美国儿童相比（危险比，1.0； 95% CI，0.7-1.4），TRAP暴露与再入院时间减少有关。非裔美国儿童总体再入院比率更高。
   结论：TRAP暴露与白种儿童再入院率增加有关，而非裔美国儿童并非如此。
 

（林江涛 审校）
J Pediatr. 2014 Mar 25. pii: S0022-3476(14)00134-6.doi:10.1016/j.jpeds.2014.02.017. [Epub ahead of print]

 

Traffic-Related Air Pollution and Asthma Hospital Readmission in Children: A Longitudinal Cohort Study.
 

Newman NC1, Ryan PH2, Huang B2, Beck AF3, Sauers HS3, Kahn RS4.
 

ABSTRACT
OBJECTIVE: To examine the association between exposure to traffic-related air pollution (TRAP) and hospital readmission for asthma or bronchodilator-responsive wheezing.
STUDY DESIGN: A population-based cohort of 758 children aged 1-16 years admitted for asthma or bronchodilator-responsive wheezing was assessed for asthma readmission within 12 months. TRAP exposure was estimated with a land use regression model using the home address at index admission, with TRAP dichotomized at the sample median (0.37 μg/m3). Covariates included allergen-specific IgE, tobacco smoke exposure, and social factors obtained at enrollment. Associations between TRAP exposure and readmission were assessed using logistic regression and Cox proportional hazards models.
RESULTS: The study cohort was 58% African American and 32% white; 19% of the patients were readmitted within 12 months of the original admission. Higher TRAP exposure was associated with a higher readmission rate (21% vs 16%; P = .05); this association was not significant after adjusting for covariates (aOR, 1.4; 95% CI, 0.9-2.2). Race modified the observed association; white children with high TRAP exposure had 3-fold higher odds of asthma readmission (OR, 3.0; 95% CI, 1.1-8.1), compared with white children with low TRAP exposure. In African American children, TRAP exposure was not associated with increased readmission (OR, 1.1; 95% CI, 0.6-1.8). In children with high TRAP exposure, TRAP exposure was associated with decreased time to readmission in white children (hazard ratio, 3.2; 95% CI, 1.5-6.7) compared with African American children (hazard ratio, 1.0; 95% CI, 0.7-1.4). African American children had a higher readmission rate overall.
CONCLUSION: TRAP exposure is associated with increased odds of hospital readmission in white children, but not in African American children.
 

J Pediatr. 2014 Mar 25. pii: S0022-3476(14)00134-6.doi:10.1016/j.jpeds.2014.02.017. [Epub ahead of print]