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Current Trends of the Prevalence of Childhood Asthma in Three Chinese Cities : a Multicenter Epidemiological Survey1

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Current Trends of the Prevalence of Childhood Asthma in Three Chinese Cities : a Multicenter Epidemiological Survey1 BIOMEDICAL AND ENVIRONMENTAL SCIENCES 23, 453-457 (2010) www.besjournal.com www.besjournal.com Current Trends of the Prevalence of Childhood Asthma in Three Chinese Cities : A Multicenter Epidemiological Survey1 * *,2 # # & & JUAN BAI , JING ZHAO , KUN-LING SHEN , LI XIANG , AI-HUAN CHEN , SUI HUANG , § $ @ YING HUANG , JIAN-SHENG WANG , AND RONG-WEI YE *Capital Institute of Pediatrics, Beijing 100020, China; #Beijing Children’s Hospital attached to Capital Medical University, Beijing 100045, China; &GuangZhou Institute of Respiratory Diseases, Guangzhou 510120, Guangdong, China; §Children’s Hospital of Chongqing Medical University, Chongqing 400014, China; $Chinese Centre for Disease Control and Prevention, Beijing 100050, China Objective To analyze the prevalence of asthma and asthma related symptoms among children aged 0-14 years in three Chinese cities and to obtain a crude estimation of the trend of childhood asthma prevalence in China. Methods A cross-sectional, population-based survey of prevalence of asthma was conducted in children aged from 0 to 14 years in 3 major cities of China (Beijing, Chongqing, and Guangzhou) with different geographic locations. All the subjects were randomly selected by a multi-stage sampling method. Three to five schools and kindergartens in 2 urban districts in each city were randomly selected for the survey, and a validated questionnaire that included the core questions of the International Study of Asthma and Allergies in Childhood, Phase III questionnaire and several additional questions were used. All questionnaires were completed by parents or guardians of the selected children. Children whose parents responded affirmatively to the question” Has your child ever been diagnosed as asthma by a doctor” were recognized as victims of asthma. Results The prevalence of asthma in Beijing, Chongqing, and Guangzhou was 3.15%, 7.45%, and 2.09%, respectively. These values were significantly higher than those obtained 10 years ago in the national epidemiological survey in 2000 which used the same method of investigation and the same diagnotic criteria (χ2=3.938, P=0.047; χ2=73.506, P≤0.001; χ2=11.956, P=0.001, in each city). Of the asthmatic children 57.21%, 69.91%, and 60.00% had their first attack before the age of 3 in Beijing, Chongqing, and Guangzhou, respectively. Wheezing was the primary clinical manifestation for all asthmatic children , followed by persistent cough and repeated respiratory infections. Both the prevalence of asthma and asthma-related symptoms were statistically higher in males than in females. Conclusion The prevalence of childhood asthma is statistically higher than that 10 years ago in the three Chinese cities. Key words: Children; Asthma; Prevalence; China INTRODUCTION was increasing at an alarming rate[9-12]. However, some Western countries have recently witnessed a Asthma is one of the most common chronic trend toward stabilization, or even reduction in the disorders in children, causing substantial prevalence of childhood asthma[13-15]. morbidity[1-2]. It increases the cost of healthcare, The prevalence of asthma in China seems to be impairs the quality of life, and decreases school lower than that in Western countries, and as China is attendance[3]. It can also be fatal, if not controlled[4-5]. vast geographically , the prevalence varies between Based on the standardized methods applied to different regions in the country[16]. Two national measure the prevalence of asthma and wheezing epidemiological surveys were conducted among illness in children, it appears that the global children aged 0-14 years in 1990 and 2000 by the prevalence of asthma ranges from 1% to 18% among Childhood Asthma Collaborative Group of China. the population in different countries[6-8]. It is reported The results of the surveys suggested that the that globally there are nearly 300 million people prevalence of childhood asthma in this country suffering from asthma and there would be over 100 increased from 0.91% to 1.54% in the period of million asthmatic patients by 2025[8]. In the 1990s, 1990-2000[17]. Over the past 10 years, however, the many studies revealed that the prevalence of asthma environment and lifestyle in China have been 1This study was supported by the National Science & Technology Pillar Program under the Eleventh Five-Year Plan of China (No.2007BAI24B05). 2Correspondence should be addressed to Jing ZHAO, Capital Institute of Pediatrics in Beijing. The authors made equal contributions to the article. E-mail: [email protected], Fax: 86-10-85625323. Biographical note of the first author: Juan BAI, female, born in 1985, master of medicine, majoring in pediatrics. 0895-3988/2010 CN 11-2816/Q Copyright © 2010 by China CDC 453 454 BAI ET AL. changing dramatically along with its economic Statistical Analysis development. No recent official statistics have been made available on the current status of childhood The data obtained were input using EpiData asthma in China. To further understand the trends of version 3.1 by two people (double data entry). All asthma in Chinese urban children in the past 10 years, statistical analyses were performed using SPSS 13.0. a cross-sectional survey was performed in 24 290 Measurement data was described by means and standard deviations, categorical data was described children aged 0-14 years in 3 Chinese major cities 2 (Beijing, Chongqing and Guangzhou) from October by the rate or ratio. The chi-square test (χ ) was used 2008 till March 2009. to compare differences in the prevalence of asthma, and asthma related symptoms among the different SUBJECTS AND METHODS cities. For all analyses, P values <0.05 were regarded as statistically significant. Study Sites and Population Ethics Our study was conducted in three major cities The study was approved by the Ethics (Beijing, Chongqing, and Guangzhou) in different Committee of the Capital Institute of Pediatrics in geographic regions of China. Beijing is located in the Beijing in March 15, 2008. Parents or legal guardians northern part of this country with a relatively low of the enrolled children were informed and were humidity, Chongqing is a low-lying region in the requested to complete a written consent form before Sichuan Basin of Southwest China, with high the survey. All patients with evidence suggestive of humidity, and Guangzhou is located in the southern asthma were investigated further, and those found to part of the country, with a subtropical climate. have asthma were offered treatment. Two urban districts were randomly selected in Beijing, Chongqing, and Guangzhou, and 3-5 schools RESULTS and kindergartens were randomly selected in each selected district. All children aged 0-14 years in the selected schools and kindergartens were enrolled in Prevalence of Asthma the survey. Two community health service centers were randomly selected and were surveyed for Overall, 24 290 children took part in the survey, of children who did not go to school or kindergarten, whom 10 372 were from Beijing, 9 846 from and received immunization service there. A total of Chongqing, and 4 072 from Guangzhou. Of these 10 372, 9 846, and 4 072 children aged 0-14 years children, 12 908 were male, and 11 382 were female. were randomly selected in Beijing, Chongqing, and The ratio of male to female in Beijing, Chongqing and Guangzhou, respectively. A validated questionnaire Guangzhou was 1.11:1, 1.15:1, and 1.13:1, respectively. which was the same as that used in the 2000 National The average age of the children in the three cities was Epidemiological Survey on Childhood Asthma was 7.63±4.04, 8.74±2.72, 8.39±3.53 years ( x ± s). administered in the survey. The questionnaire Asthma was defined as a “yes” response to the included the core questions of the International Study question “Has your child ever been diagnosed as of Asthma and Allergies in Childhood, Phase III asthma by a doctor”. The prevalence of asthma in questionnaire, and several additional questions on Beijing, Chongqing, and Guangzhou was 3.15%, asthma and its related symptoms. In order to ensure 7.45%, 2.09%, respectively. These values were the credibility of the survey, reliability test was done significantly higher than those ten years ago (the to the questionnaire and the Cronbach’s α and Kappa respective prevalence of asthma in Beijing, statistic of the questionnaire were 0.82 and 0.81, Chongqing and Guangzhou was 2.69%, 4.63%, and respectively. 1.33% according to the 2000 National The schoolchildren in our survey were informed Epidemiological Survey in which the same method of [18] of the objective of the survey and were asked to survey was employed) . In these cities, the request their parents to complete the questionnaire, prevalence of wheezing in the last 12 month was and to return them to schools. For the children who 5.54%, 3.48%, and 3.93%, respectively; the were not old enough to attend school, investigators prevalence of dry cough at night was 8.71%, 8.65%, conducted a face-to-face interview with their parents and 8.79%, respectively. The prevalence of cough in the kindergartens or in the community health induced by exercise was 6.80%, 7.14%, and 8.45%, service centers where the children received respectively. Overall, 68.50%, 56.54%, and 68.24% immunization service. of asthmatic children in the three cities had asthma- CURRENT TRENDS OF CHILDHOOD ASTHMA IN CHINA 455 TABLE 1 Prevalence of Asthma and Asthma-Related Symptoms in the Last 12 Months City Beijing Chongqing Guangzhou Total Asthma Male 223 (4.09) 432 (8.22) 55 (2.55) 710 (5.50) Female 101 (2.05) 278 (6.06) 30 (1.60) 409 (3.59) Total 324 (3.15) 710 (7.45) 85 (7.09) 1119 (4.16) χ2 33.599 17.033 4.388 45.704 P <0.001 <0.001 0.036 <0.001 Asthma Related Symptoms Wheezing 575 (5.54) 343 (3.48) 160 (3.93) 1078 (4.44) Coughing at Night 903 (8.71) 852 (8.65) 358 (8.79) 2113 (8.70) Exercise-induced Cough 705 (6.80) 703 (7.14) 344 (8.45) 1752 (7.21) Note.
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