Which population level environmental factors are associated with asthma, rhinoconjunctivitis and eczema? Review of the ecological analyses of ISAAC Phase One

M. Innes Asher; Alistair W. Stewart; Javier Mallol; Stephen Montefort; Christopher K.W. Lai; Nadia Aït-Khaled; Joseph Odhiambo; G. Anabwani; H. R. Anderson; T. O. Clayton; P. Ellwood; E. A. Mitchell; R. Beasley; B. Björkstén; M. L. Burr; J. Crane; U. Keil; F. Martinez; N. Pearce; C. F. Robertson; J. R. Shah; B. Sibbald; D. P. Strachan; E. von Mutius; S. K. Weiland; H. C. Williams; A. Bezzaoucha; K. Melaku; B. Seyoum; F. O. Esamai; B. O. Onadeko; H. Nelson; Y. Z. Chen; K. H. Chen; N. S. Zhong; M. Bao-Shan; M. L. Xiao; Y. L. Lau; K. Baratawidjaja; S. Nishima; K. H. Teh; L. W. Yeong; J. de Bruyne; B. S. Quah; K. W. Chum; F. Cua-Lim; S. I. Lee; B. W. Lee; K. H. Hsieh; P. Vichyanond; M. Trakultivakorn; M. R. Masjedi; J. A. al-Momen; F. M. Ramadan; B. M.S. Al Riyami; Z. Bouayad; A. Bennis; Z. A. Bhutta; N. Salmun; N. Rosário; R. Stein; P. G.M. Bezerra; L. deFreitas Souza; D. Solé; I. Sanchez; L. Amarales; E. Cortez; M. A. Calvo; C. Soto-Quirós; I. Romieu; G. Cukier; J. A. Guggiari-Chase; P. Chiarella; D. Holgado; M. R. Sears; B. Taylor; V. Persky; G. J. Redding; D. Jeffs; C. R. Grainger; A. Priftanji; M. A. Riikjärv; M. Kajosaari; J. Pekkanen; L. Soininen; T. A. Koivikko; N. Khetsuriani; A. Gamkrelidze; M. Leja; G. Lis; A. Brêborowicz; D. Dumitrascu; R. M. Khaitov; N. I. Kjellman; T. Foucard; T. Aripova; D. Kennedy; L. Landau; J. Peat; A. Bauman; C. Moyes; P. Pattemore; D. Barry; R. Mackay; R. M. Maheshwari; M. K. Joshi; U. A. Pai; K. Raghavan; V. A. Khatav; L. Kumar; K. C. Jain; T. U. Sukumaran; S. Rajajee; N. Somu; K. Chopra; G. Jayaraj; P. K. Kar; N. M. Hanumante; J. Riedler; G. Haidinger; P. Vermeire; D. Charpin; P. Godard; A. Taytard; C. Kopferschmitt; I. Annesi-Maesano; A. Kramer; C. Gratziou; P. V. Powell; S. Bonini; E. Bonci; F. Rusconi; M. Biocca; L. Chetoni; E. Chellini; R. Ronchetti; L. Bisanti; F. Forastiere; E. Renzoni; G. Ciccone; S. Piffer; A. Boner; G. Corbo; F. D. Borges; J. E. Rosado Pinto; C. Nunes; J. M. Lopesdos Santos; L. Clancy; R. M. Busquets; A. D. Rubio; A. R. Asensio; L. García-Marcos; A. Arnedo-Pena; F. Guillén-Grima; M. M. Morales-Suárez-Varela; A. Blanco Quirós; M. H. Shamssain; D. Strachan

doi:10.1186/1465-9921-11-8

Which population level environmental factors are associated with asthma, rhinoconjunctivitis and eczema? Review of the ecological analyses of ISAAC Phase One

M. Innes Asher, Alistair W. Stewart, Javier Mallol, Stephen Montefort, Christopher K.W. Lai, Nadia Aït-Khaled, Joseph Odhiambo, G. Anabwani, H. R. Anderson, T. O. Clayton, P. Ellwood, E. A. Mitchell, R. Beasley, B. Björkstén, M. L. Burr, J. Crane, U. Keil, F. Martinez, N. Pearce, C. F. RobertsonJ. R. Shah, B. Sibbald, D. P. Strachan, E. von Mutius, S. K. Weiland, H. C. Williams, A. Bezzaoucha, K. Melaku, B. Seyoum, F. O. Esamai, B. O. Onadeko, H. Nelson, Y. Z. Chen, K. H. Chen, N. S. Zhong, M. Bao-Shan, M. L. Xiao, Y. L. Lau, K. Baratawidjaja, S. Nishima, K. H. Teh, L. W. Yeong, J. de Bruyne, B. S. Quah, K. W. Chum, F. Cua-Lim, S. I. Lee, B. W. Lee, K. H. Hsieh, P. Vichyanond, M. Trakultivakorn, M. R. Masjedi, J. A. al-Momen, F. M. Ramadan, B. M.S. Al Riyami, Z. Bouayad, A. Bennis, Z. A. Bhutta, N. Salmun, N. Rosário, R. Stein, P. G.M. Bezerra, L. deFreitas Souza, D. Solé, I. Sanchez, L. Amarales, E. Cortez, M. A. Calvo, C. Soto-Quirós, I. Romieu, G. Cukier, J. A. Guggiari-Chase, P. Chiarella, D. Holgado, M. R. Sears, B. Taylor, V. Persky, G. J. Redding, D. Jeffs, C. R. Grainger, A. Priftanji, M. A. Riikjärv, M. Kajosaari, J. Pekkanen, L. Soininen, T. A. Koivikko, N. Khetsuriani, A. Gamkrelidze, M. Leja, G. Lis, A. Brêborowicz, D. Dumitrascu, R. M. Khaitov, N. I. Kjellman, T. Foucard, T. Aripova, D. Kennedy, L. Landau, J. Peat, A. Bauman, C. Moyes, P. Pattemore, D. Barry, R. Mackay, R. M. Maheshwari, M. K. Joshi, U. A. Pai, K. Raghavan, V. A. Khatav, L. Kumar, K. C. Jain, T. U. Sukumaran, S. Rajajee, N. Somu, K. Chopra, G. Jayaraj, P. K. Kar, N. M. Hanumante, J. Riedler, G. Haidinger, P. Vermeire, D. Charpin, P. Godard, A. Taytard, C. Kopferschmitt, I. Annesi-Maesano, A. Kramer, C. Gratziou, P. V. Powell, S. Bonini, E. Bonci, F. Rusconi, M. Biocca, L. Chetoni, E. Chellini, R. Ronchetti, L. Bisanti, F. Forastiere, E. Renzoni, G. Ciccone, S. Piffer, A. Boner, G. Corbo, F. D. Borges, J. E. Rosado Pinto, C. Nunes, J. M. Lopesdos Santos, L. Clancy, R. M. Busquets, A. D. Rubio, A. R. Asensio, L. García-Marcos, A. Arnedo-Pena, F. Guillén-Grima, M. M. Morales-Suárez-Varela, A. Blanco Quirós, M. H. Shamssain, D. Strachan

Institute for Global Health and Development, Pakistan

Research output: Contribution to journal › Review article › peer-review

99 Citations (Scopus)

Abstract

The International Study of Asthma and Allergies in Childhood (ISAAC) Phase One showed large worldwide variations in the prevalence of symptoms of asthma, rhinoconjunctivitis and eczema, up to 10 to 20 fold between countries. Ecological analyses were undertaken with ISAAC Phase One data to explore factors that may have contributed to these variations, and are summarised and reviewed here. In ISAAC Phase One the prevalence of symptoms in the past 12 months of asthma, rhinoconjunctivitis and eczema were estimated from studies in 463,801 children aged 13 - 14 years in 155 centres in 56 countries, and in 257,800 children aged 6-7 years in 91 centres in 38 countries. Ecological analyses were undertaken between symptom prevalence and the following: Gross National Product per capita (GNP), food intake, immunisation rates, tuberculosis notifications, climatic factors, tobacco consumption, pollen, antibiotic sales, paracetamol sales, and outdoor air pollution.Symptom prevalence of all three conditions was positively associated with GNP, trans fatty acids, paracetamol, and women smoking, and inversely associated with food of plant origin, pollen, immunisations, tuberculosis notifications, air pollution, and men smoking. The magnitude of these associations was small, but consistent in direction between conditions. There were mixed associations of climate and antibiotic sales with symptom prevalence.The potential causality of these associations warrant further investigation. Factors which prevent the development of these conditions, or where there is an absence of a positive correlation at a population level may be as important from the policy viewpoint as a focus on the positive risk factors. Interventions based on small associations may have the potential for a large public health benefit.

Original language	English
Article number	8
Journal	Respiratory Research
Volume	11
DOIs	https://doi.org/10.1186/1465-9921-11-8
Publication status	Published - 21 Jan 2010

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Cite this

Innes Asher, M., Stewart, A. W., Mallol, J., Montefort, S., Lai, C. K. W., Aït-Khaled, N., Odhiambo, J., Anabwani, G., Anderson, H. R., Clayton, T. O., Ellwood, P., Mitchell, E. A., Beasley, R., Björkstén, B., Burr, M. L., Crane, J., Keil, U., Martinez, F., Pearce, N., ... Strachan, D. (2010). Which population level environmental factors are associated with asthma, rhinoconjunctivitis and eczema? Review of the ecological analyses of ISAAC Phase One. Respiratory Research, 11, Article 8. https://doi.org/10.1186/1465-9921-11-8

@article{76876a85af944520969a926a29248dc7,

title = "Which population level environmental factors are associated with asthma, rhinoconjunctivitis and eczema? Review of the ecological analyses of ISAAC Phase One",

abstract = "The International Study of Asthma and Allergies in Childhood (ISAAC) Phase One showed large worldwide variations in the prevalence of symptoms of asthma, rhinoconjunctivitis and eczema, up to 10 to 20 fold between countries. Ecological analyses were undertaken with ISAAC Phase One data to explore factors that may have contributed to these variations, and are summarised and reviewed here. In ISAAC Phase One the prevalence of symptoms in the past 12 months of asthma, rhinoconjunctivitis and eczema were estimated from studies in 463,801 children aged 13 - 14 years in 155 centres in 56 countries, and in 257,800 children aged 6-7 years in 91 centres in 38 countries. Ecological analyses were undertaken between symptom prevalence and the following: Gross National Product per capita (GNP), food intake, immunisation rates, tuberculosis notifications, climatic factors, tobacco consumption, pollen, antibiotic sales, paracetamol sales, and outdoor air pollution.Symptom prevalence of all three conditions was positively associated with GNP, trans fatty acids, paracetamol, and women smoking, and inversely associated with food of plant origin, pollen, immunisations, tuberculosis notifications, air pollution, and men smoking. The magnitude of these associations was small, but consistent in direction between conditions. There were mixed associations of climate and antibiotic sales with symptom prevalence.The potential causality of these associations warrant further investigation. Factors which prevent the development of these conditions, or where there is an absence of a positive correlation at a population level may be as important from the policy viewpoint as a focus on the positive risk factors. Interventions based on small associations may have the potential for a large public health benefit.",

author = "{Innes Asher}, M. and Stewart, {Alistair W.} and Javier Mallol and Stephen Montefort and Lai, {Christopher K.W.} and Nadia A{\"i}t-Khaled and Joseph Odhiambo and G. Anabwani and Anderson, {H. R.} and Clayton, {T. O.} and P. Ellwood and Mitchell, {E. A.} and R. Beasley and B. Bj{\"o}rkst{\'e}n and Burr, {M. L.} and J. Crane and U. Keil and F. Martinez and N. Pearce and Robertson, {C. F.} and Shah, {J. R.} and B. Sibbald and Strachan, {D. P.} and {von Mutius}, E. and Weiland, {S. K.} and Williams, {H. C.} and A. Bezzaoucha and K. Melaku and B. Seyoum and Esamai, {F. O.} and Onadeko, {B. O.} and H. Nelson and Chen, {Y. Z.} and Chen, {K. H.} and Zhong, {N. S.} and M. Bao-Shan and Xiao, {M. L.} and Lau, {Y. L.} and K. Baratawidjaja and S. Nishima and Teh, {K. H.} and Yeong, {L. W.} and {de Bruyne}, J. and Quah, {B. S.} and Chum, {K. W.} and F. Cua-Lim and Lee, {S. I.} and Lee, {B. W.} and Hsieh, {K. H.} and P. Vichyanond and M. Trakultivakorn and Masjedi, {M. R.} and al-Momen, {J. A.} and Ramadan, {F. M.} and {Al Riyami}, {B. M.S.} and Z. Bouayad and A. Bennis and Bhutta, {Z. A.} and N. Salmun and N. Ros{\'a}rio and R. Stein and Bezerra, {P. G.M.} and {deFreitas Souza}, L. and D. Sol{\'e} and I. Sanchez and L. Amarales and E. Cortez and Calvo, {M. A.} and C. Soto-Quir{\'o}s and I. Romieu and G. Cukier and Guggiari-Chase, {J. A.} and P. Chiarella and D. Holgado and Sears, {M. R.} and B. Taylor and V. Persky and Redding, {G. J.} and D. Jeffs and Grainger, {C. R.} and A. Priftanji and Riikj{\"a}rv, {M. A.} and M. Kajosaari and J. Pekkanen and L. Soininen and Koivikko, {T. A.} and N. Khetsuriani and A. Gamkrelidze and M. Leja and G. Lis and A. Br{\^e}borowicz and D. Dumitrascu and Khaitov, {R. M.} and Kjellman, {N. I.} and T. Foucard and T. Aripova and D. Kennedy and L. Landau and J. Peat and A. Bauman and C. Moyes and P. Pattemore and D. Barry and R. Mackay and Maheshwari, {R. M.} and Joshi, {M. K.} and Pai, {U. A.} and K. Raghavan and Khatav, {V. A.} and L. Kumar and Jain, {K. C.} and Sukumaran, {T. U.} and S. Rajajee and N. Somu and K. Chopra and G. Jayaraj and Kar, {P. K.} and Hanumante, {N. M.} and J. Riedler and G. Haidinger and P. Vermeire and D. Charpin and P. Godard and A. Taytard and C. Kopferschmitt and I. Annesi-Maesano and A. Kramer and C. Gratziou and Powell, {P. V.} and S. Bonini and E. Bonci and F. Rusconi and M. Biocca and L. Chetoni and E. Chellini and R. Ronchetti and L. Bisanti and F. Forastiere and E. Renzoni and G. Ciccone and S. Piffer and A. Boner and G. Corbo and Borges, {F. D.} and {Rosado Pinto}, {J. E.} and C. Nunes and {Lopesdos Santos}, {J. M.} and L. Clancy and Busquets, {R. M.} and Rubio, {A. D.} and Asensio, {A. R.} and L. Garc{\'i}a-Marcos and A. Arnedo-Pena and F. Guill{\'e}n-Grima and Morales-Su{\'a}rez-Varela, {M. M.} and {Blanco Quir{\'o}s}, A. and Shamssain, {M. H.} and D. Strachan",

note = "Funding Information: The authors are indebted to the collaborators in the participating centres and all parents, children, teachers and other school staff who participated in the surveys. There are many field workers and funding agencies who supported data collection and national, regional and international meetings, including the meetings of the ISAAC Steering Committee. Unfortunately, these are too numerous to mention (they are acknowledged elsewhere) but the authors particularly wish to thank the funders who supported the ISAAC International Data Centre including the Health Research Council of New Zealand, the Asthma and Respiratory Foundation of New Zealand, the National Child Health Research Foundation, the Hawke{\textquoteright}s Bay Medical Research Foundation, the Waikato Medical Research Foundation, Glaxo Wellcome New Zealand and Astra New Zealand, as well as Glaxo Wellcome International Medical Affairs for finding the regional coordinating centres. The International Data Centre is now supported by a grant from the BUPA Foundation. ISAAC Phase One study group ISAAC Steering Committee: N A{\"i}t-Khaled (Union Internationale Contre la Tuberculose et les Maladies Respiratoires, Paris, France); G Anabwani (Princess Marina Hospital, Gaborone, Botswana); HR Anderson (St Georges, University of London and MRC Centre for Environment and Health, London, UK); MI Asher (Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand); R Beasley (Medical Research Institute of New Zealand, Wellington, New Zealand); B Bj{\"o}rkst{\'e}n (National Institute of Environmental Medicine/IMM, Karolinska Institutet, Stockholm, Sweden); ML Burr (Department of Primary Care & Public Health, Cardiff University Neuadd Meirionnydd, Cardiff, UK); J Crane (Wellington Asthma Research Group, Wellington School of Medicine, New Zealand); U Keil (Institut f{\"u}r Epidemiologie und Sozialmedizin, Westf{\"a}lische Wilhelms Universit{\"a}t, M{\"u}nster, Germany); CKW Lai (Department of Medicine and Therapeutics, The Chinese University of Hong Kong, SAR China); J Mallol (Department of Pediatric Respiratory Medicine, University of Santiago de Chile, Chile); F Martinez (Arizona Respiratory Center, University of Arizona, Tucson, Arizona, USA); EA Mitchell (Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand); S Montefort (Department of Medicine, University of Malta, Malta); N Pearce (Centre for Public Health Research, Massey University, Wellington, New Zealand); CF Robertson (Murdoch Children{\textquoteright}s Research Institute, Melbourne, Australia); JR Shah (Jaslok Hospital & Research Centre, Mumbai, India); B Sibbald, (University of Manchester, Manchester, UK); AW Stewart (Population Health, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand); DP Strachan (Division of Community Health Sciences, St Georges Hospital Medical School, London, UK); E von Mutius (Dr von Haunerschen Kinderklinik de Universit{\"a}t M{\"u}nchen, Germany); SK Weiland* (Department of Epidemiology, University of Ulm, Germany); HC Williams (Centre for Evidence Based Dermatology, Nottingham University Hospital{\textquoteright}s Queen{\textquoteright}s Medical Centre, Nottingham, UK). *Deceased ISAAC International Data Centre: MI Asher, TO Clayton, P Ellwood, EA Mitchell, (Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand); AW Stewart, (School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand). ISAAC Phase One Principal Investigators: Africa Algeria: A Bezzaoucha (Algiers); Ethiopia: K Melaku* (Addis Ababa), B Seyoum (Jima); Kenya: FO Esamai (Eldoret), JA Odhiambo* (Nairobi); Nigeria: BO Onadeko (Ibadan); South Africa: H Nelson (Cape Town); Asia Pacific China: Y-Z Chen* (Beijing), K-H Chen (Chongqing), N-S Zhong (Guangzhou), M Bao-Shan (Shanghai), M-L Xiao (Wulumuqi); Hong Kong: C Lai* (Hong Kong 13-14 yr), YL Lau (Hong Kong 6-7 yr); Indonesia: Dr K Baratawidjaja* (Bandung); Japan: S Nishima (Fukuoka); Malaysia: KH Teh (Alor Setar), LW Yeong (Ipoh), J de Bruyne* (Klang Valley), BS Quah (Kota Bharu), KW Chum (Muar); Philippines: F Cua-Lim (Metro Manilla); South Korea: S-I Lee* (Provincial Korea and Seoul); Singapore: B-W Lee (Singapore); Taiwan: K-H Hsieh* (deceased) (Taipei); Thailand: P Vichyanond* (Bangkok), M Trakultivakorn (Chiang Mai); Eastern Mediterranean Iran: M-R Masjedi* (Rasht and Tehran); Kuwait: JA al-Momen (Kuwait); Lebanon: FM Ramadan (Beirut); Oman: BMS Al Riyami (Al-Khod); Malta: S Montefort (Malta); Morocco: Z Bouayad* (Casablanca and Marrakech), A Bennis (Rabat); Pakistan: ZA Bhutta (Karachi); Latin America Argentina: N Salmun* (Buenos Aires and Rosario); Brazil: N Ros{\'a}rio (Curitiba), R Stein (Porto Alegre), PGM Bezerra (Recife), L de Freitas Souza (Salvador), D Sol{\'e}* (Sao Paulo); Chile: I Sanchez (Central Santiago), L Amarales (Punta Arenas), E Cortez (South Santiago), MA Calvo (Valdivia); Costa Rica (ME Soto-Quir{\'o}s), Mexico: I Romieu (Cuernavaca); Panama: G Cukier (David-Panama); Paraguay: JA Guggiari-Chase (Asuncion); Peru: P Chiarella (Lima); Uruguay: D Holgado (Montevideo); North America Canada: MR Sears* (Hamilton), B Taylor (Saskatoon); USA: V Persky (Chicago [3]), GJ Redding (Seattle); Northern and Eastern Europe Albania: A Priftanji (Tirane); Estonia: M-A Riikj{\"a}rv* (Narva and Tallinn); Finland: M Kajosaari (Helsinki), J Pekkanen* (Kuopio County), L Soininen (Lapland Area), TA Koivikko (Turku and Pori County); Georgia: N Khetsuriani (Kutaisi), A Gamkrelidze* (Tbilisi); Latvia: M Leja* (Riga and Rural Latvia); Poland: G Lis* (Krakow), A Br{\^e}borowicz (Poznan); Romania: D Dumitrascu (Cluj); Russia: RM Khaitov (Moscow); Sweden: N-I Kjellman (Link{\"o}ping), T Foucard (Stockholm/Uppsala); Uzbekistan: T Aripova* (Samarkand and Tashkent); Oceania Australia: D Kennedy (Adelaide), CF Robertson* (Melbourne), L Landau (Perth), J Peat (Sydney 6-7 yr), A Bauman (Sydney 13-14 yr); New Zealand: MI Asher* (Auckland), C Moyes (Bay of Plenty), P Pattemore (Christchurch), D Barry (Hawke{\textquoteright}s Bay), R Mackay (Nelson), J Crane (Wellington); Indian Subcontinent India: RM Maheshwari (Akola), MK Joshi (Bombay [16]), UA Pai (Bombay [17]), K Raghavan (Bombay [18]), VA Khatav (Borivali), L Kumar (Chandigarh), KC Jain (Jodhpur), TU Sukumaran (Kottayam), S Rajajee (Madras [2]), N Somu (Madras [3]), K Chopra (New Delhi [7]), G Jayaraj (Neyveli), PK Kar (Orissa), NM Hanumante (Pune); Western Europe Austria: J Riedler* (Salzburg), G Haidinger (Urfahr-Umgebung); Belgium: P Vermeire (Antwerp); Channel Islands: D Jeffs (Guernsey), CR Grainger (Jersey), France: D Charpin* (Marseilles), P Godard (Montpellier), A Taytard (Pessac), C Kopferschmitt (Strasbourg), I Annesi-Maesano (West Marne); Germany: A Kramer (Greifswald), U Keil* (Munster); Greece: C Gratziou (Athens); Isle of Man (PV Powell), Italy: S Bonini (Ascoli Piceno), E Bonci (Cosenza), F Rusconi (Cremona), M Biocca (Emilia-Romagna), L Chetoni (Empoli), E Chellini (Firenze), R Ronchetti (Frosinone), L Bisanti (Milano), F Forastiere* (Roma), E Renzoni (Siena), G Ciccone (Torino), S Piffer (Trento), A Boner (Verona), G Corbo (Viterbo); Portugal: FD Borges (Funchal), JE Rosado Pinto* (Lisbon), C Nunes (Portim{\~a}o), JM Lopes dos Santos (Porto); Republic of Ireland: L Clancy (Rep of Ireland); Spain: RM Busquets (Barcelona), AD Rubio (Bilbao), AR Asensio (Cadiz), L Garc{\'i}a-Marcos* (Cartagena), A Arnedo-Pena (Castellon), F Guill{\'e}n-Grima (Pamplona), MM Morales-Su{\'a}rez-Varela (Valencia), A Blanco Quir{\'o}s (Valladolid); United Kingdom: HR Anderson* (Anglia and Oxford, North East and Yorkshire, North Thames, North West, South and West, South Thames, Scotland, Trent, Wales, West Midlands), MH Shamssain (Sunderland), D Strachan (Surrey/Sussex). *National Coordinator National Coordinators not identified above Chile: J Mallol; India: J Shah 1Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand. 2School of Population Health, The University of Auckland, Auckland, New Zealand. 3Department of Pediatric Respiratory Medicine, University of Santiago de Chile (USACH), Hospital El Pino, Santiago, Chile. 4Department of Medicine, University of Malta, Malta. 5Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR PR China. 6International Union Against Tuberculosis Lung Diseases, Paris, France. 7Centre for Respiratory Diseases Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya. 8Members listed at the end of the manuscript.",

year = "2010",

month = jan,

day = "21",

doi = "10.1186/1465-9921-11-8",

language = "English",

volume = "11",

journal = "Respiratory Research",

issn = "1465-9921",

publisher = "BioMed Central Ltd.",

}

Innes Asher, M, Stewart, AW, Mallol, J, Montefort, S, Lai, CKW, Aït-Khaled, N, Odhiambo, J, Anabwani, G, Anderson, HR, Clayton, TO, Ellwood, P, Mitchell, EA, Beasley, R, Björkstén, B, Burr, ML, Crane, J, Keil, U, Martinez, F, Pearce, N, Robertson, CF, Shah, JR, Sibbald, B, Strachan, DP, von Mutius, E, Weiland, SK, Williams, HC, Bezzaoucha, A, Melaku, K, Seyoum, B, Esamai, FO, Onadeko, BO, Nelson, H, Chen, YZ, Chen, KH, Zhong, NS, Bao-Shan, M, Xiao, ML, Lau, YL, Baratawidjaja, K, Nishima, S, Teh, KH, Yeong, LW, de Bruyne, J, Quah, BS, Chum, KW, Cua-Lim, F, Lee, SI, Lee, BW, Hsieh, KH, Vichyanond, P, Trakultivakorn, M, Masjedi, MR, al-Momen, JA, Ramadan, FM, Al Riyami, BMS, Bouayad, Z, Bennis, A, Bhutta, ZA, Salmun, N, Rosário, N, Stein, R, Bezerra, PGM, deFreitas Souza, L, Solé, D, Sanchez, I, Amarales, L, Cortez, E, Calvo, MA, Soto-Quirós, C, Romieu, I, Cukier, G, Guggiari-Chase, JA, Chiarella, P, Holgado, D, Sears, MR, Taylor, B, Persky, V, Redding, GJ, Jeffs, D, Grainger, CR, Priftanji, A, Riikjärv, MA, Kajosaari, M, Pekkanen, J, Soininen, L, Koivikko, TA, Khetsuriani, N, Gamkrelidze, A, Leja, M, Lis, G, Brêborowicz, A, Dumitrascu, D, Khaitov, RM, Kjellman, NI, Foucard, T, Aripova, T, Kennedy, D, Landau, L, Peat, J, Bauman, A, Moyes, C, Pattemore, P, Barry, D, Mackay, R, Maheshwari, RM, Joshi, MK, Pai, UA, Raghavan, K, Khatav, VA, Kumar, L, Jain, KC, Sukumaran, TU, Rajajee, S, Somu, N, Chopra, K, Jayaraj, G, Kar, PK, Hanumante, NM, Riedler, J, Haidinger, G, Vermeire, P, Charpin, D, Godard, P, Taytard, A, Kopferschmitt, C, Annesi-Maesano, I, Kramer, A, Gratziou, C, Powell, PV, Bonini, S, Bonci, E, Rusconi, F, Biocca, M, Chetoni, L, Chellini, E, Ronchetti, R, Bisanti, L, Forastiere, F, Renzoni, E, Ciccone, G, Piffer, S, Boner, A, Corbo, G, Borges, FD, Rosado Pinto, JE, Nunes, C, Lopesdos Santos, JM, Clancy, L, Busquets, RM, Rubio, AD, Asensio, AR, García-Marcos, L, Arnedo-Pena, A, Guillén-Grima, F, Morales-Suárez-Varela, MM, Blanco Quirós, A, Shamssain, MH & Strachan, D 2010, 'Which population level environmental factors are associated with asthma, rhinoconjunctivitis and eczema? Review of the ecological analyses of ISAAC Phase One', Respiratory Research, vol. 11, 8. https://doi.org/10.1186/1465-9921-11-8

TY - JOUR

T1 - Which population level environmental factors are associated with asthma, rhinoconjunctivitis and eczema? Review of the ecological analyses of ISAAC Phase One

AU - Innes Asher, M.

AU - Stewart, Alistair W.

AU - Mallol, Javier

AU - Montefort, Stephen

AU - Lai, Christopher K.W.

AU - Aït-Khaled, Nadia

AU - Odhiambo, Joseph

AU - Anabwani, G.

AU - Anderson, H. R.

AU - Clayton, T. O.

AU - Ellwood, P.

AU - Mitchell, E. A.

AU - Beasley, R.

AU - Björkstén, B.

AU - Burr, M. L.

AU - Crane, J.

AU - Keil, U.

AU - Martinez, F.

AU - Pearce, N.

AU - Robertson, C. F.

AU - Shah, J. R.

AU - Sibbald, B.

AU - Strachan, D. P.

AU - von Mutius, E.

AU - Weiland, S. K.

AU - Williams, H. C.

AU - Bezzaoucha, A.

AU - Melaku, K.

AU - Seyoum, B.

AU - Esamai, F. O.

AU - Onadeko, B. O.

AU - Nelson, H.

AU - Chen, Y. Z.

AU - Chen, K. H.

AU - Zhong, N. S.

AU - Bao-Shan, M.

AU - Xiao, M. L.

AU - Lau, Y. L.

AU - Baratawidjaja, K.

AU - Nishima, S.

AU - Teh, K. H.

AU - Yeong, L. W.

AU - de Bruyne, J.

AU - Quah, B. S.

AU - Chum, K. W.

AU - Cua-Lim, F.

AU - Lee, S. I.

AU - Lee, B. W.

AU - Hsieh, K. H.

AU - Vichyanond, P.

AU - Trakultivakorn, M.

AU - Masjedi, M. R.

AU - al-Momen, J. A.

AU - Ramadan, F. M.

AU - Al Riyami, B. M.S.

AU - Bouayad, Z.

AU - Bennis, A.

AU - Bhutta, Z. A.

AU - Salmun, N.

AU - Rosário, N.

AU - Stein, R.

AU - Bezerra, P. G.M.

AU - deFreitas Souza, L.

AU - Solé, D.

AU - Sanchez, I.

AU - Amarales, L.

AU - Cortez, E.

AU - Calvo, M. A.

AU - Soto-Quirós, C.

AU - Romieu, I.

AU - Cukier, G.

AU - Guggiari-Chase, J. A.

AU - Chiarella, P.

AU - Holgado, D.

AU - Sears, M. R.

AU - Taylor, B.

AU - Persky, V.

AU - Redding, G. J.

AU - Jeffs, D.

AU - Grainger, C. R.

AU - Priftanji, A.

AU - Riikjärv, M. A.

AU - Kajosaari, M.

AU - Pekkanen, J.

AU - Soininen, L.

AU - Koivikko, T. A.

AU - Khetsuriani, N.

AU - Gamkrelidze, A.

AU - Leja, M.

AU - Lis, G.

AU - Brêborowicz, A.

AU - Dumitrascu, D.

AU - Khaitov, R. M.

AU - Kjellman, N. I.

AU - Foucard, T.

AU - Aripova, T.

AU - Kennedy, D.

AU - Landau, L.

AU - Peat, J.

AU - Bauman, A.

AU - Moyes, C.

AU - Pattemore, P.

AU - Barry, D.

AU - Mackay, R.

AU - Maheshwari, R. M.

AU - Joshi, M. K.

AU - Pai, U. A.

AU - Raghavan, K.

AU - Khatav, V. A.

AU - Kumar, L.

AU - Jain, K. C.

AU - Sukumaran, T. U.

AU - Rajajee, S.

AU - Somu, N.

AU - Chopra, K.

AU - Jayaraj, G.

AU - Kar, P. K.

AU - Hanumante, N. M.

AU - Riedler, J.

AU - Haidinger, G.

AU - Vermeire, P.

AU - Charpin, D.

AU - Godard, P.

AU - Taytard, A.

AU - Kopferschmitt, C.

AU - Annesi-Maesano, I.

AU - Kramer, A.

AU - Gratziou, C.

AU - Powell, P. V.

AU - Bonini, S.

AU - Bonci, E.

AU - Rusconi, F.

AU - Biocca, M.

AU - Chetoni, L.

AU - Chellini, E.

AU - Ronchetti, R.

AU - Bisanti, L.

AU - Forastiere, F.

AU - Renzoni, E.

AU - Ciccone, G.

AU - Piffer, S.

AU - Boner, A.

AU - Corbo, G.

AU - Borges, F. D.

AU - Rosado Pinto, J. E.

AU - Nunes, C.

AU - Lopesdos Santos, J. M.

AU - Clancy, L.

AU - Busquets, R. M.

AU - Rubio, A. D.

AU - Asensio, A. R.

AU - García-Marcos, L.

AU - Arnedo-Pena, A.

AU - Guillén-Grima, F.

AU - Morales-Suárez-Varela, M. M.

AU - Blanco Quirós, A.

AU - Shamssain, M. H.

AU - Strachan, D.

N1 - Funding Information: The authors are indebted to the collaborators in the participating centres and all parents, children, teachers and other school staff who participated in the surveys. There are many field workers and funding agencies who supported data collection and national, regional and international meetings, including the meetings of the ISAAC Steering Committee. Unfortunately, these are too numerous to mention (they are acknowledged elsewhere) but the authors particularly wish to thank the funders who supported the ISAAC International Data Centre including the Health Research Council of New Zealand, the Asthma and Respiratory Foundation of New Zealand, the National Child Health Research Foundation, the Hawke’s Bay Medical Research Foundation, the Waikato Medical Research Foundation, Glaxo Wellcome New Zealand and Astra New Zealand, as well as Glaxo Wellcome International Medical Affairs for finding the regional coordinating centres. The International Data Centre is now supported by a grant from the BUPA Foundation. ISAAC Phase One study group ISAAC Steering Committee: N Aït-Khaled (Union Internationale Contre la Tuberculose et les Maladies Respiratoires, Paris, France); G Anabwani (Princess Marina Hospital, Gaborone, Botswana); HR Anderson (St Georges, University of London and MRC Centre for Environment and Health, London, UK); MI Asher (Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand); R Beasley (Medical Research Institute of New Zealand, Wellington, New Zealand); B Björkstén (National Institute of Environmental Medicine/IMM, Karolinska Institutet, Stockholm, Sweden); ML Burr (Department of Primary Care & Public Health, Cardiff University Neuadd Meirionnydd, Cardiff, UK); J Crane (Wellington Asthma Research Group, Wellington School of Medicine, New Zealand); U Keil (Institut für Epidemiologie und Sozialmedizin, Westfälische Wilhelms Universität, Münster, Germany); CKW Lai (Department of Medicine and Therapeutics, The Chinese University of Hong Kong, SAR China); J Mallol (Department of Pediatric Respiratory Medicine, University of Santiago de Chile, Chile); F Martinez (Arizona Respiratory Center, University of Arizona, Tucson, Arizona, USA); EA Mitchell (Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand); S Montefort (Department of Medicine, University of Malta, Malta); N Pearce (Centre for Public Health Research, Massey University, Wellington, New Zealand); CF Robertson (Murdoch Children’s Research Institute, Melbourne, Australia); JR Shah (Jaslok Hospital & Research Centre, Mumbai, India); B Sibbald, (University of Manchester, Manchester, UK); AW Stewart (Population Health, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand); DP Strachan (Division of Community Health Sciences, St Georges Hospital Medical School, London, UK); E von Mutius (Dr von Haunerschen Kinderklinik de Universität München, Germany); SK Weiland* (Department of Epidemiology, University of Ulm, Germany); HC Williams (Centre for Evidence Based Dermatology, Nottingham University Hospital’s Queen’s Medical Centre, Nottingham, UK). *Deceased ISAAC International Data Centre: MI Asher, TO Clayton, P Ellwood, EA Mitchell, (Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand); AW Stewart, (School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand). ISAAC Phase One Principal Investigators: Africa Algeria: A Bezzaoucha (Algiers); Ethiopia: K Melaku* (Addis Ababa), B Seyoum (Jima); Kenya: FO Esamai (Eldoret), JA Odhiambo* (Nairobi); Nigeria: BO Onadeko (Ibadan); South Africa: H Nelson (Cape Town); Asia Pacific China: Y-Z Chen* (Beijing), K-H Chen (Chongqing), N-S Zhong (Guangzhou), M Bao-Shan (Shanghai), M-L Xiao (Wulumuqi); Hong Kong: C Lai* (Hong Kong 13-14 yr), YL Lau (Hong Kong 6-7 yr); Indonesia: Dr K Baratawidjaja* (Bandung); Japan: S Nishima (Fukuoka); Malaysia: KH Teh (Alor Setar), LW Yeong (Ipoh), J de Bruyne* (Klang Valley), BS Quah (Kota Bharu), KW Chum (Muar); Philippines: F Cua-Lim (Metro Manilla); South Korea: S-I Lee* (Provincial Korea and Seoul); Singapore: B-W Lee (Singapore); Taiwan: K-H Hsieh* (deceased) (Taipei); Thailand: P Vichyanond* (Bangkok), M Trakultivakorn (Chiang Mai); Eastern Mediterranean Iran: M-R Masjedi* (Rasht and Tehran); Kuwait: JA al-Momen (Kuwait); Lebanon: FM Ramadan (Beirut); Oman: BMS Al Riyami (Al-Khod); Malta: S Montefort (Malta); Morocco: Z Bouayad* (Casablanca and Marrakech), A Bennis (Rabat); Pakistan: ZA Bhutta (Karachi); Latin America Argentina: N Salmun* (Buenos Aires and Rosario); Brazil: N Rosário (Curitiba), R Stein (Porto Alegre), PGM Bezerra (Recife), L de Freitas Souza (Salvador), D Solé* (Sao Paulo); Chile: I Sanchez (Central Santiago), L Amarales (Punta Arenas), E Cortez (South Santiago), MA Calvo (Valdivia); Costa Rica (ME Soto-Quirós), Mexico: I Romieu (Cuernavaca); Panama: G Cukier (David-Panama); Paraguay: JA Guggiari-Chase (Asuncion); Peru: P Chiarella (Lima); Uruguay: D Holgado (Montevideo); North America Canada: MR Sears* (Hamilton), B Taylor (Saskatoon); USA: V Persky (Chicago [3]), GJ Redding (Seattle); Northern and Eastern Europe Albania: A Priftanji (Tirane); Estonia: M-A Riikjärv* (Narva and Tallinn); Finland: M Kajosaari (Helsinki), J Pekkanen* (Kuopio County), L Soininen (Lapland Area), TA Koivikko (Turku and Pori County); Georgia: N Khetsuriani (Kutaisi), A Gamkrelidze* (Tbilisi); Latvia: M Leja* (Riga and Rural Latvia); Poland: G Lis* (Krakow), A Brêborowicz (Poznan); Romania: D Dumitrascu (Cluj); Russia: RM Khaitov (Moscow); Sweden: N-I Kjellman (Linköping), T Foucard (Stockholm/Uppsala); Uzbekistan: T Aripova* (Samarkand and Tashkent); Oceania Australia: D Kennedy (Adelaide), CF Robertson* (Melbourne), L Landau (Perth), J Peat (Sydney 6-7 yr), A Bauman (Sydney 13-14 yr); New Zealand: MI Asher* (Auckland), C Moyes (Bay of Plenty), P Pattemore (Christchurch), D Barry (Hawke’s Bay), R Mackay (Nelson), J Crane (Wellington); Indian Subcontinent India: RM Maheshwari (Akola), MK Joshi (Bombay [16]), UA Pai (Bombay [17]), K Raghavan (Bombay [18]), VA Khatav (Borivali), L Kumar (Chandigarh), KC Jain (Jodhpur), TU Sukumaran (Kottayam), S Rajajee (Madras [2]), N Somu (Madras [3]), K Chopra (New Delhi [7]), G Jayaraj (Neyveli), PK Kar (Orissa), NM Hanumante (Pune); Western Europe Austria: J Riedler* (Salzburg), G Haidinger (Urfahr-Umgebung); Belgium: P Vermeire (Antwerp); Channel Islands: D Jeffs (Guernsey), CR Grainger (Jersey), France: D Charpin* (Marseilles), P Godard (Montpellier), A Taytard (Pessac), C Kopferschmitt (Strasbourg), I Annesi-Maesano (West Marne); Germany: A Kramer (Greifswald), U Keil* (Munster); Greece: C Gratziou (Athens); Isle of Man (PV Powell), Italy: S Bonini (Ascoli Piceno), E Bonci (Cosenza), F Rusconi (Cremona), M Biocca (Emilia-Romagna), L Chetoni (Empoli), E Chellini (Firenze), R Ronchetti (Frosinone), L Bisanti (Milano), F Forastiere* (Roma), E Renzoni (Siena), G Ciccone (Torino), S Piffer (Trento), A Boner (Verona), G Corbo (Viterbo); Portugal: FD Borges (Funchal), JE Rosado Pinto* (Lisbon), C Nunes (Portimão), JM Lopes dos Santos (Porto); Republic of Ireland: L Clancy (Rep of Ireland); Spain: RM Busquets (Barcelona), AD Rubio (Bilbao), AR Asensio (Cadiz), L García-Marcos* (Cartagena), A Arnedo-Pena (Castellon), F Guillén-Grima (Pamplona), MM Morales-Suárez-Varela (Valencia), A Blanco Quirós (Valladolid); United Kingdom: HR Anderson* (Anglia and Oxford, North East and Yorkshire, North Thames, North West, South and West, South Thames, Scotland, Trent, Wales, West Midlands), MH Shamssain (Sunderland), D Strachan (Surrey/Sussex). *National Coordinator National Coordinators not identified above Chile: J Mallol; India: J Shah 1Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand. 2School of Population Health, The University of Auckland, Auckland, New Zealand. 3Department of Pediatric Respiratory Medicine, University of Santiago de Chile (USACH), Hospital El Pino, Santiago, Chile. 4Department of Medicine, University of Malta, Malta. 5Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR PR China. 6International Union Against Tuberculosis Lung Diseases, Paris, France. 7Centre for Respiratory Diseases Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya. 8Members listed at the end of the manuscript.

PY - 2010/1/21

Y1 - 2010/1/21

N2 - The International Study of Asthma and Allergies in Childhood (ISAAC) Phase One showed large worldwide variations in the prevalence of symptoms of asthma, rhinoconjunctivitis and eczema, up to 10 to 20 fold between countries. Ecological analyses were undertaken with ISAAC Phase One data to explore factors that may have contributed to these variations, and are summarised and reviewed here. In ISAAC Phase One the prevalence of symptoms in the past 12 months of asthma, rhinoconjunctivitis and eczema were estimated from studies in 463,801 children aged 13 - 14 years in 155 centres in 56 countries, and in 257,800 children aged 6-7 years in 91 centres in 38 countries. Ecological analyses were undertaken between symptom prevalence and the following: Gross National Product per capita (GNP), food intake, immunisation rates, tuberculosis notifications, climatic factors, tobacco consumption, pollen, antibiotic sales, paracetamol sales, and outdoor air pollution.Symptom prevalence of all three conditions was positively associated with GNP, trans fatty acids, paracetamol, and women smoking, and inversely associated with food of plant origin, pollen, immunisations, tuberculosis notifications, air pollution, and men smoking. The magnitude of these associations was small, but consistent in direction between conditions. There were mixed associations of climate and antibiotic sales with symptom prevalence.The potential causality of these associations warrant further investigation. Factors which prevent the development of these conditions, or where there is an absence of a positive correlation at a population level may be as important from the policy viewpoint as a focus on the positive risk factors. Interventions based on small associations may have the potential for a large public health benefit.

AB - The International Study of Asthma and Allergies in Childhood (ISAAC) Phase One showed large worldwide variations in the prevalence of symptoms of asthma, rhinoconjunctivitis and eczema, up to 10 to 20 fold between countries. Ecological analyses were undertaken with ISAAC Phase One data to explore factors that may have contributed to these variations, and are summarised and reviewed here. In ISAAC Phase One the prevalence of symptoms in the past 12 months of asthma, rhinoconjunctivitis and eczema were estimated from studies in 463,801 children aged 13 - 14 years in 155 centres in 56 countries, and in 257,800 children aged 6-7 years in 91 centres in 38 countries. Ecological analyses were undertaken between symptom prevalence and the following: Gross National Product per capita (GNP), food intake, immunisation rates, tuberculosis notifications, climatic factors, tobacco consumption, pollen, antibiotic sales, paracetamol sales, and outdoor air pollution.Symptom prevalence of all three conditions was positively associated with GNP, trans fatty acids, paracetamol, and women smoking, and inversely associated with food of plant origin, pollen, immunisations, tuberculosis notifications, air pollution, and men smoking. The magnitude of these associations was small, but consistent in direction between conditions. There were mixed associations of climate and antibiotic sales with symptom prevalence.The potential causality of these associations warrant further investigation. Factors which prevent the development of these conditions, or where there is an absence of a positive correlation at a population level may be as important from the policy viewpoint as a focus on the positive risk factors. Interventions based on small associations may have the potential for a large public health benefit.

UR - http://www.scopus.com/inward/record.url?scp=77952484434&partnerID=8YFLogxK

U2 - 10.1186/1465-9921-11-8

DO - 10.1186/1465-9921-11-8

M3 - Review article

C2 - 20092649

AN - SCOPUS:77952484434

SN - 1465-9921

VL - 11

JO - Respiratory Research

JF - Respiratory Research

M1 - 8

ER -

Which population level environmental factors are associated with asthma, rhinoconjunctivitis and eczema? Review of the ecological analyses of ISAAC Phase One

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