Abstract
Asthma prevalence in children varies substantially around the world, but the contribution of known risk factors to this international variation is uncertain. The International Study of Asthma and Allergies in Childhood (ISAAC) Phase Two studied 8–12 year old children in 30 centres worldwide with parent-completed symptom and risk factor questionnaires and aeroallergen skin prick testing. We used multilevel logistic regression modelling to investigate the effect of adjustment for individual and ecological risk factors on the between-centre variation in prevalence of recent wheeze. Adjustment for single individual-level risk factors changed the centre-level variation from a reduction of up to 8.4% (and 8.5% for atopy) to an increase of up to 6.8%. Modelling the 11 most influential environmental factors among all children simultaneously, the centre-level variation changed little overall (2.4% increase). Modelling only factors that decreased the variance, the 6 most influential factors (synthetic and feather quilt, mother’s smoking, heating stoves, dampness and foam pillows) in combination resulted in a 21% reduction in variance. Ecological (centre-level) risk factors generally explained higher proportions of the variation than did individual risk factors. Single environmental factors and aeroallergen sensitisation measured at the individual (child) level did not explain much of the between-centre variation in wheeze prevalence.
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Acknowledgements
We wish to thank all children, parents, teachers, field workers and lab workers for their enormous contributions to this collaborative study.
Funding
This work was supported by the German Research Foundation (DFG) (Grant No. WE 4306/3-1).
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All investigators in the Phase Two Study Group are listed in the “Appendix”.
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Appendix: The ISAAC Phase Two Study group
Appendix: The ISAAC Phase Two Study group
The ISAAC Phase Two Coordinating and Data Centre: S.K. Weiland† (Director), G. Büchele, C. Dentler, A. Jaensch, P. Rzehak, G. Weinmayr (Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany).
The principal investigators: A. Priftanji, A. Shkurti, J. Simenati, E. Grabocka, K. Shyti, S. Agolli, A. Gurakuqi (Tirana, Albania); R.T. Stein, M. Urrutia de Pereira, M.H. Jones, P.M. Pitrez (Uruguaiana, Brazil); P.J. Cooper, M. Chico (Pichincha province, Ecuador); Y.Z. Chen (Beijing, China); N.S Zhong (Guangzhou, China); C.K.W. Lai (National Coordinator), G.W.K. Wong (Hong Kong, China); M-A. Riikjärv, T. Annus (Tallinn, Estonia); I. Annesi-Maesano (Créteil, France); M. Gotua, M. Rukhadze, T. Abramidze, I. Kvachadze, L. Karsanidze, M. Kiladze, N. Dolidze (Tbilisi, Georgia); W. Leupold, U. Keil, E. von Mutius, S.K. Weiland† (Dresden, Germany); E. von Mutius, U. Keil, S.K. Weiland† (Munich, Germany); P. Arthur†, E. Addo-Yobo (Kintampo, Ghana); C. Gratziou (National Coordinator), K. Priftis, A. Papadopoulou, C. Katsardis (Athens, Greece); J. Tsanakas, E. Hatziagorou, F. Kirvassilis (Thessaloniki, Greece); M. Clausen (Reykjavik, Iceland); J.R. Shah, R.S. Mathur, R.P. Khubchandani, S. Mantri (Mumbai, India); F. Forastiere, R. Di Domenicantonio, M. De Sario, S. Sammarro, R. Pistelli, M.G. Serra, G. Corbo, C.A. Perucci (Rome, Italy); V. Svabe, D. Sebre, G. Casno, I. Novikova, L. Bagrade (Riga, Latvia); B. Brunekreef, D. Schram, G. Doekes, P.H.N. Jansen-van Vliet, N.A.H. Janssen, F.J.H. Aarts, G. de Meer (Utrecht, the Netherlands); J. Crane, K. Wickens, D. Barry (Hawkes Bay, New Zealand); W. Nystad, R. Bolle, E. Lund (Tromsø, Norway); J. Batlles Garrido, T. Rubi Ruiz, A. Bonillo Perales, Y. Gonzalez Jiménez, J. Aguirre Rodriguez, J. Momblan de Cabo, A. Losilla Maldonado, M. Daza Torres (Almeria, Spain); L. García-Marcos (National Coordinator), A. Martinez Torres, J.J. Guillén Pérez, A. Piñana López, S. Castejon Robles (Cartagena, Spain); G. García Hernandez, A. Martinez Gimeno, A.L. Moro Rodríguez, C. Luna Paredes, I. Gonzalez Gil (Madrid, Spain); M.M. Morales Suarez-Varela, A. Llopis González, A. Escribano Montaner, M. Tallon Guerola (Valencia, Spain); L. Bråbäck (National Coordinator), M. Kjellman, L. Nilsson, X-M. Mai (Linköping, Sweden); L. Bråbäck, A. Sandin (Östersund, Sweden); Y. Saraçlar, S. Kuyucu, A. Tuncer, C. Saçkesen, V. Sumbulŏglu, P. Geyik, C. Kocabas¸ (Ankara, Turkey); D.P. Strachan, B. Kaur (West Sussex, UK); N. El-Sharif, B. Nemery, F. Barghuthy, S. Abu Huij, M. Qlebo (Ramallah, West Bank); M. van Hage (IgE analyses - Stockholm, Sweden).
The ISAAC Steering Committee: N. Aït-Khaled (Paris, France); H.R. Anderson and D.P. Strachan* (London, UK); C. Flohr* and H. Williams (Nottingham, UK); F. Forastiere* (Rome, Italy); I. Asher, P. Ellwood, A. Stewart and E. Mitchell (Auckland, New Zealand); J. Crane, N. Pearce and R. Beasley (Wellington, New Zealand); B. Björkstén (Stockholm, Sweden); B. Brunekreef* (Utrecht, the Netherlands); S. Foliaki (Nuku’alofa, Kingdom of Tonga); L. García-Marcos (Murcia, Spain); E. von Mutius* (Munich, Germany); U. Keil (Münster, Germany); S.K. Weiland*†, G. Weinmayr* (Ulm, Germany); C.K.W. Lai and G.W.K. Wong (Hong Kong, China); J. Mallol (Santiago, Chile); S. Montefort (Naxxar, Malta); J. Odhiambo† (Nairobi, Kenya); and C. Robertson (Parkville, Australia).
*Also members of the ISAAC Phase Two Steering Group, †Deceased.
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Weinmayr, G., Jaensch, A., Ruelius, AK. et al. Can environment or allergy explain international variation in prevalence of wheeze in childhood?. Eur J Epidemiol 34, 509–520 (2019). https://doi.org/10.1007/s10654-018-0463-z
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DOI: https://doi.org/10.1007/s10654-018-0463-z