环境暴露与环境出生队列中母亲和儿童幼儿期反复喘息的相关性:时间到事件研究。

IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Thorax Pub Date : 2024-09-18 DOI:10.1136/thorax-2023-221150
Kareshma Asharam, Aweke A Abebaw Mitku, Lisa Ramsay, Prakash Mohan Jeena, Rajen N Naidoo
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引用次数: 0

摘要

背景:产前因素和环境暴露会导致幼儿期反复喘息:产前因素和环境暴露会导致幼儿期反复喘息。目的:采用时间到事件分析法,在母婴环境队列中确定与出生至 48 个月儿童反复喘息相关的产前因素和环境因素:方法:对孕期和产后的母亲进行访谈,对出生至 48 个月(2013 年 5 月至 2019 年 10 月)的儿童进行随访。混合土地利用回归和分散模型描述了居民产前接触二氧化氮(NO2)和直径为2.5微米的颗粒物(PM2.5)的情况。喘息状况由临床医生进行评估。卡普兰-梅耶危害函数和考克斯比例危害模型提供了风险估计值,并对暴露于环境烟草烟雾(ETS)、产妇吸烟、生物质燃料使用和室内环境因素进行了调整:在520对母子中,有85名(16%)儿童出现过一次喘息,57名(11%)儿童出现过反复喘息。与母亲使用电力的儿童(分别为 45.9 个月和 38.9 个月(P=0.03))相比,接触生物质烹饪燃料的儿童出现反复喘息(42.9 个月)和单次喘息(37.8 个月)的时间明显较短。与未接触产前排放有毒有害物质的儿童相比,母亲接触产前排放有毒有害物质的儿童出现反复喘息的几率是未接触产前排放有毒有害物质的儿童的 3.8 倍(调整后 HR 为 3.8,95% CI 为 1.3 至 10.7)。与无喘息者相比,复发性喘息者出生月份的二氧化氮平均值明显较高。二氧化氮和PM2.5与调整后增加2%-4%的喘息风险有关:结论:控制产前暴露于排放有毒物质和生物质燃料可能会延缓出生至 48 个月儿童反复喘息的发生。
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Environmental exposures associated with early childhood recurrent wheezing in the mother and child in the environment birth cohort: a time-to-event study.

Background: Antenatal factors and environmental exposures contribute to recurrent wheezing in early childhood.

Aim: To identify antenatal and environmental factors associated with recurrent wheezing in children from birth to 48 months in the mother and child in the environment cohort, using time-to-event analysis.

Method: Maternal interviews were administered during pregnancy and postnatally and children were followed up from birth to 48 months (May 2013-October 2019). Hybrid land-use regression and dispersion modelling described residential antenatal exposure to nitrogen dioxide (NO2) and particulate matter of 2.5 µm diameter (PM2.5). Wheezing status was assessed by a clinician. The Kaplan-Meier hazard function and Cox-proportional hazard models provided estimates of risk, adjusting for exposure to environmental tobacco smoke (ETS), maternal smoking, biomass fuel use and indoor environmental factors.

Results: Among 520 mother-child pairs, 85 (16%) children, had a single wheeze episode and 57 (11%) had recurrent wheeze. Time to recurrent wheeze (42.9 months) and single wheeze (37.8 months) among children exposed to biomass cooking fuels was significantly shorter compared with children with mothers using electricity (45.9 and 38.9 months, respectively (p=0.03)). Children with mothers exposed to antenatal ETS were 3.8 times more likely to have had recurrent wheeze compared with those not exposed (adjusted HR 3.8, 95% CI 1.3 to 10.7). Mean birth month NO2 was significantly higher among the recurrent wheeze category compared with those without wheeze. NO2 and PM2.5 were associated with a 2%-4% adjusted increased wheezing risk.

Conclusion: Control of exposure to ETS and biomass fuels in the antenatal period is likely to delay the onset of recurrent wheeze in children from birth to 48 months.

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来源期刊
Thorax
Thorax 医学-呼吸系统
CiteScore
16.10
自引率
2.00%
发文量
197
审稿时长
1 months
期刊介绍: Thorax stands as one of the premier respiratory medicine journals globally, featuring clinical and experimental research articles spanning respiratory medicine, pediatrics, immunology, pharmacology, pathology, and surgery. The journal's mission is to publish noteworthy advancements in scientific understanding that are poised to influence clinical practice significantly. This encompasses articles delving into basic and translational mechanisms applicable to clinical material, covering areas such as cell and molecular biology, genetics, epidemiology, and immunology.
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