Abstract
Prevalence of age-dependent diseases such as asthma is confounded not only by aging effects but also by cohort and period effects. Age-period-cohort (APC) analysis is commonly performed to isolate the effects of these three factors from two-way tables of prevalence by age and birth cohort. However, APC analysis suffers from technical difficulties such as non-identifiability problems. We isolated the effects of these three factors in a step-by-step manner by analyzing Japan’s school health data collected from 1984 to 2004 focusing on asthma prevalence among school children aged 6–17 years consisting of 30 birth cohorts (entering classes). We verified the accuracy of our method showing high agreement of the observed age-, period- and cohort-specific data and the data predicted by our method. The aging effects were found to follow cubic equations whose multinomial coefficients were determined by an optimization technique. The obtained aging effect curves of age-specific asthma prevalence showed that boys reach the peak prevalence at 13 and girls at 14, declining markedly afterward. The cohort effects, defined as the arithmetic asthma prevalence means for ages 6–17 years, showed consistent upward trends for the 30 birth cohorts born in 1968–97 for both sexes. The period effects showed a consistent decline since 1984 but abruptly increased in 1999 and then declined again. We were not able to identify the exact cause of the increase in 1999, therefore, this should be examined in the future studies. Because the cohort effects show no sign of leveling off yet, asthma prevalence will likely increase in the foreseeable future.
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References
Sunyer J, Anto JM, Tobias A, Burney P. Generational increase of self-reported first attack of asthma in fifteen industrialized countries European Community Respiratory Health Study (ECRHS). Eur Respir J. 1999;14:885–891.
Hong SJ, Lee MS, Sohn MH, Shim JY, Han YS, Park KS, et al. Korean ISAAC Study Group. Self-reported prevalence and risk factors of asthma among Korean adolescents: 5-year follow-up study, 1995–2000. Clin Exp Allergy. 2004;34:1556–1562.
Wong GW, Leung TF, Ko FW, Lee KK, Lam P, Hui DS, et al. Declining asthma prevalence in Hong Kong Chinese school-children. Clin Exp Allergy. 2004;34:1550–1555.
Tanihara S, Nakamura Y, Oki I, Ojima T, Yanagawa H. Trends in asthma morbidity and mortality in Japan between 1984 and 1996. J Epidemiol. 2002;12:217–222.
Tanihara S, Kobayashi Y. Sequential evaluation of the national medical expenditures for asthma care in Japan. J Epidemiol. 2004;14:100–103.
Petronella SA, Conboy-Ellis K. Asthma epidemiology: risk factors, case finding, and the role of asthma coalitions. Nurs Clin North Am. 2003;38:725–735.
Osmond C, Gardner MJ. Age, period and cohort models applied to cancer mortality rates. Stat Med. 1982;1:245–259.
Robertson C, Boyle P. Age, period and cohort models: The use of individual records. Stat Med. 1986;5:527–538.
Robertson C, Gandini S, Boyle P. Age-period-cohort models: a comparative study of available methodologies. J Clin Epidemiol. 1999;52:569–583.
Nakamura T. Cohort analysis of data obtained using a multiple choice question. In: Nishisato S, Baba Y, Bozdogan H, Kanefuji K editors. Measurement and Multivariate Analysis. Tokyo: Springer-Verlag; 2002. p. 241–248.
Robertson C, Boyle P. Age, period and cohort models: the use of individual records. Stat Med. 1986;5:527–538.
Kupper LL, Janis JM, Karmous A, Greenberg BG. Statistical age-period-cohort analysis: a review and critique. J Chronic Dis. 1985;38:811–830.
Akazawa A, et al. National age-specific survey on prevalence, incidence and QOL of bronchial asthma. Health, Labor & Welfare research grants report. March 2006.
Ministry of Health, Labor & Welfare, Bureau of Statistics & Information. 2004 National Household Survey. Health & Welfare Statistics Association.
Huber TE, Joseph SW, Knoblock E, Redfearn PL, Karakawa JA. New environmental respiratory disease (Yokohama asthma); preliminary report. AMA Archives of Industrial Hygiene. 1954;11:394–418.
Yoshida K, Oshima H, Imai M. Air pollution and asthma in Yokkaichi. Arch Environ Health. 1966;13:763–768.
Namekata T, Florey CV (ed). Health Effects of Air Pollution and the Japanese Compensation Law. Battelle Press; 1987.
Namekata T. The evaluation of an asthma panel survey: were high ambient SO2 concentrations associated with asthma attacks? Japanese Journal of Public Health. 1987;34:309–316. (Article in Japanese)
Shimizu T. Prevalence of cough symptoms among school children and air pollution. Japanese Journal of Air Pollution. 1987;22:57–71. (Article in Japanese)
Yura A. Trends in the prevalence rate of wheezing in school children. Allergy. 1996;45:451–460. (Article in Japanese)
Manuel DG, Mao Y. Avoidable mortality in the United States and Canada, 1980–1996. Am J Public Health. 2002;92:1481–1484.
Suissa S, Ernst P. Use of anti-inflammatory therapy and asthma mortality in Japan. Eur Respir J. 2003;21:101–104.
Tanihara S, Nakamura Y, Matsui T, Nishima S. A case-control study of asthma death and life-threatening attack: their possible relationship with prescribed drug therapy in Japan. J Epidemiol. 2002;12:223–228.
Miyake Y, Yura A, Iki M. Cross-sectional study of allergic disorders in relation to familial factors in Japanese adolescents. Acta Paediatr. 2004;93:380–385.
Strong WB, Malina RM, Blimkie CJ, Daniels SR, Dishman RK, Gutin B, et al. Evidence based physical activities for school-age youth. J Pediatr. 2005;146:732–737.
Shima M. Health effects of air pollution by exhaustive gas from automobiles. Chiba Medicine. 2005;81:1–9. (Article in Japanese)
Kokumin Eisei no Doko 2006, J of Health & Welfare Statistics 2006;53:314–315. Health & Welfare Statistics Association. (Article in Japanese).
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Okamoto, E., Hata, E., Kobayashi, M. et al. Age-period-cohort analysis of asthma prevalence among school children. Environ Health Prev Med 12, 119–128 (2007). https://doi.org/10.1007/BF02898026
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DOI: https://doi.org/10.1007/BF02898026