Incidence and prevalence of adult asthma is associated with low socio‐economic status

Background: Low socio‐economic status is often related to health problems; however, previous studies on asthma, usually cross‐sectional, yield inconsistent results. In this study, longitudinal and cross‐sectional data on the association between socio‐economic status and asthma as well as respiratory symptoms among adults are presented. Methods: A postal questionnaire was sent on two occasions, 1996 and 2006, to a randomly selected sample of subjects aged 20–69 years in 1996. In total, 4479 subjects participated in both surveys. The questionnaire included questions on asthma, respiratory symptoms and possible determinants. Logistic regression analysis, adjusted for potential confounders, was used to study the association between asthma, respiratory symptoms and socio‐economic status. Results: Manual workers in service had the highest prevalence and cumulative incidence for all investigated symptoms and asthma. Despite a large decrease in smokers, the increase in incident bronchitic symptoms was higher than the increase of incident asthma and incident asthmatic symptoms. Low socio‐economic status, rhinitis and a family history of asthma were risk factors for having and developing asthma and respiratory symptoms. Conclusion: Low socio‐economic status is significantly associated with an increased risk for prevalent and incident asthma and respiratory symptoms in this longitudinal population‐based survey. The increase in risk was most pronounced in manual workers. Several studies have recently shown an association between low socio‐economic status and respiratory symptoms and we conclude that asthma can not be considered as a disease that mainly affects the middle and upper socio‐economic classes. Please cite this paper as: Ekerljung L, Sundblad B‐M, Rönmark E, Larsson K and Lundbäck B. Incidence and prevalence of adult asthma is associated with low socio‐economic status. The Clinical Respiratory Journal 2010; 4: 147–156.     

Noninvasive ventilation in New Zealand: a national prevalence survey

Background

Home-based noninvasive ventilation (NIV) is an effective treatment for a range of conditions that cause respiratory failure which reduces hospitalisation and mortality and improves quality of life.

Aims

To collect NIV prevalence, disease burden and equity data needed for effective national NIV health service planning.

Methods

The authors collected demographics and the primary diagnosis of patients receiving publicly funded NIV in New Zealand in 2018 by surveying all providers. National and regional prevalence rates were calculated using adult population data (aged ≥20 years) for each District Health Board region compared with a 2011 study. A subanalysis of individual-level data was used to calculate age-standardised rates by diagnostic category.

Results

A total of 1197 adults were receiving NIV giving a national rate of 32.9 per 100 000; almost twice the 2011 rate (16.7 per 100 000). Significant regional variations in NIV provision (4.5–84.2 per 100 000) were observed. The most frequent indications were obesity hypoventilation syndrome (OHS) (562, 47%), obstructive pathologies (335, 28%) and neuromuscular disorders (175, 15%); all have significantly increased in prevalence since 2011. Māori and Pacific peoples were significantly overrepresented among NIV users (2.24 [95% confidence interval (CI), 1.72–2.93] and 7.03 [95% CI, 5.52–8.94], respectively). The prevalence of NIV-dependent use (>15 h/day) was 4%.

Conclusions

Home-based NIV provision has doubled since the previous survey, reflecting increased burden from OHS and obstructive pathologies and a disproportionate disease burden among Māori and Pacific populations. The large regional variations are concerning and highlight the urgent requirement for national service specifications, education and equipment provision. Further research is needed to address access equity.     

Problems of measuring asthma prevalence

Abstract This review considers the issues involved in measuring the community prevalence of asthma, particularly in the context of international comparisons. We argue that there is no gold standard definition for measuring asthma prevalence, and discuss the currently available methods of case ascertainment. Prevalence studies, if they are to be generalizable, need to involve large sample sizes with high response rates. This necessitates methods that are simple, inexpensive and practicable, but also as sensitive and specific for asthma as possible. We discuss some of the issues that are specific to comparisons of asthma prevalence between diverse populations, and suggest that large surveys using written or video questionnaires of self reported symptoms validated in all of the target populations are the method of choice.     

The prevalence of asthma and related symptoms in Middle East countries

Objectives

Asthma is a chronic inflammatory airway disease characterized by reversible airway constriction and airway hyperresponsiveness. Asthma is a worldwide problem and its prevalence varies among different parts of the world. There are insufficient data about the prevalence and risk factors of this disease in Middle East countries.

Data source

The objective of this review article was to determine the prevalence of asthma in Middle East countries by searching EMBASE, Medline, Web of Science and Google Scholar for articles about asthma prevalence in children and adults in this region.

Study selection

The prevalence of asthma in different countries and different cities of each country in the Middle East was reviewed in children and adults of both sexes. The possible risk factors for asthma in different areas were also reviewed from 1985 to 2012.

Results

The highest asthma prevalence in children and adults was 35.4% in Tehran, Iran by ISAAC phase I and 15% in Kuwait by self‐designed questionnaire and the lowest prevalence was 1% in Kermanshah, Iran by ISAAC and 2% in Tehran, Iran by ECRHS questionnaire, respectively. Most studies showed that the prevalence of this common disease declines with increasing age.

Conclusion

The data showed that the prevalence of asthma varies among different countries and even among different cities of the same country. The common risk factors for this disease were genetic predisposition, cigarette smoking, family history of asthma and allergic diseases.     

International comparison of asthma prevalence in children: Australia,Switzerland, Chile

The aim of the study was to determine if the prevalence of symptoms suggestive of asthma in school-age children was similar in three countries with differing language and culture. To answer this question, we used the same instrument, translated appropriately, for schoolchildren in Melbourne, Australia, St. Gallen, Switzerland, and La Serena, Chile. A three page respiratory symptoms questionnaire was issued to schools for distribution to children for completion by parents and return to the school. Three age groups were selected for study, based on the average age of the school grade. Grades were used with average ages of 7, 12, and 15 years, respectively. A total of 26,628 questionnaires were issued to parents (Australia, 10,981; Switzerland, 4.464; Chile, 11,163). The response rates for each country were 89% for Australia, 97.5% for Switzerland, and 71% for Chile. The prevalence of wheezing in the last 12 months for 7 year olds was 23.1% in Melbourne, 7.4% in St. Gallen, and 26.5% in La Serena; for 12 year olds it was 20.9% in Melbourne, 6.0% in St. Gallen, and 21.l% in La Serena; for 15 year olds it was 18.6% in Melbourne, 4.5% in St. Gallen, and 17.7% in La Serene. A history of wheezing was more common in boys than girls at age 7 in Melbourne and St. Gallen, but not La Serena. This difference was less at age 12 and was not seen at age 15. Among those who had reported wheezing in the last 12 months, bronchodilator use was reported by 83% (1,611/1,948) from Melbourne, 46% (1 18/259) from St. Gallen, and 47% (538/1,140) from La Serena. The prevalence of respiratory symptoms reported from Switzerland was much lower than that for Australia or Chile. Now that a difference in the prevalence of asthma symptoms has been demonstrated, it may be desirable to compare environmental factors between countries with different prevalence rates. Pediatr Pulmonol. 1993; 16:219–226. © 1993 Wiley-Liss, Inc.     

Racial and ethnic differences in asthma and mental health among US adults: results from the national survey on drug use and health

Objective: Evaluate the racial and ethnic differences in asthma and mental health comorbidity. Methods: A secondary analysis of 2008–2013 National Survey on Drug Use and Health was conducted, resulting in a total of 206?993 civilian adult respondents to evaluate the association between asthma and mental health (past year serious psychological distress [SPD] and doctor diagnosis of depression). Both survey weighted bivariate (chi-square) and multivariable (binary logistic) regression analyses, after accounting for control variables, were conducted to evaluate the asthma/mental health nexus. A p value of less than 0.05 was used to denote significance. Results: Current asthma was significantly associated with past year SPD for non-Hispanic Whites (adjusted odds ratio [aOR] = 1.45), Hispanics (aOR?=?1.68), and Black/African Americans (aOR?=?1.47). A similar association was noted for current asthma and past year doctor diagnosis of depression (non-Hispanic White aOR?=?1.74; Hispanics aOR?=?1.77; Black/African American aOR?=?1.62). Among those with lifetime asthma, higher odds of SPD were reported for non-Hispanic Whites (aOR?=?1.42), Hispanics (aOR?=?1.64), and Black/African Americans (aOR?=?1.50). Lifetime asthma also significantly associated with past year doctor diagnosis of depression for non-Hispanic Whites (aOR?=?1.42), Hispanics (aOR?=?1.41), and Black/African Americans (aOR?=?1.46). Conclusion: Our results demonstrate the significant burden of asthma and mental health comorbidity among diverse racial and ethnic groups. Improved public health efforts through promotion of integrated care for early screening and preventive measures are needed to alleviate the burden for at-risk groups.     

Prevalence of asthma symptoms among the adult population in the city of Mashhad (north-east of Iran)

OBJECTIVE: Although there is evidence of worldwide variation in the prevalence of asthma, the prevalence of asthma in adult populations in Iran is not known. METHODS: We studied the prevalence of asthma symptoms among the adult population (aged 20 years and over) in the city of Mashhad using a questionnaire. A total of 5579 subjects, comprising 2835 males and 2744 females, were interviewed by trained medical students. The following were used as asthma symptoms in the questionnaire: recurrent wheeze, recurrent cough or tightness at rest, night cough and wheeze or cough during exercise. Subjects with two symptoms or who had been previously diagnosed with asthma were considered as having asthma. RESULTS: The results showed that 158 subjects (2.8%), comprising 69 males (2.4%) and 89 females (3.2%), had asthma. The proportion of subjects with a family history of asthma (40.5%), a history of allergy (43.7%) and a smoking habit (24.5%) was significantly higher than in normal subjects. Of the subjects determined to have asthma, 120 (76%) had been previously diagnosed as having asthma and were under treatment. However, only 65 subjects (41.1%) were currently under treatment. CONCLUSION: These results suggested a 2.8% prevalence of asthma among the adult population in the city of Mashhad, most of whom had been previously diagnosed and were under treatment.     

The International Diabetes Federation diabetes atlas methodology for estimating global and national prevalence of diabetes in adults

Introduction

Diabetes is a major cause of morbidity and mortality and its global prevalence is growing rapidly. A simple and robust approach to estimate the prevalence of diabetes is essential for governments to set priorities on how to meet the challenges of the disease. The International Diabetes Federation has developed a methodology for generating country-level estimates of diabetes prevalence in adults (20-79 years).

Methods

Using country-level data sources from peer-reviewed studies, national health statistics reports, commissioned studies on diabetes prevalence, and unpublished data obtained through personal communication, we use logistic regression to generate estimates of the prevalence of diabetes. An approach matching countries on ethnicity, geography, and income group is used to fill in gaps where original data sources are not available. The methodology also uses changes in urbanization and population to generate estimates and projections on the prevalence of diabetes in adults.

Conclusion

Diabetes prevalence estimates are very sensitive to the data from which they are derived. The revised IDF methodology for estimating diabetes prevalence is a transparent, reproducible approach that will be updated annually. It takes data-driven approaches to filling in gaps where data are not available and where assumptions have to be made. It uses a qualification system to rank data sources so that only the highest quality data are used.     

The prevalence,predictors and associations of hypertension in Sri Lanka: a cross-sectional population based national survey

We studied the community prevalence, patterns and predictors of hypertension in a large sub-population of South Asian adults with a view of identifying differential risk factors. Data were collected between years 2005–2006 and 5000 adults were invited for the study. The sample size was 4485, and about 39.5% were males. Mean systolic and diastolic blood pressures were 127.1?±?19.8?mmHg and 75.4?±?11.3?mmHg, respectively. Age-adjusted prevalence in all adults, males and females was 23.7%, 23.4% and 23.8%, respectively. Urban adults had a significantly higher prevalence of hypertension than rural adults. In the binary logistic–regression analysis, male gender (OR: 1.2), increasing age, Sri Lankan Moor ethnicity (OR: 1.6), physical inactivity (OR: 1.7), presence of diabetes (OR: 2.2) and central obesity (OR: 2.3) all were significantly associated with hypertension. In conclusion, nearly one-third of the Sri Lankan adult population is hypertensive. Hence, public health initiatives should encourage healthier lifestyles with emphasis on preventing obesity and increasing physical activity.     

High prevalence of asthma in preschool children in Southern Brazil: a population-based study

The prevalence of asthma is increasing in many countries. To measure asthma's prevalence, a sample of 981 children aged 4 years old belonging to a birth cohort from 1993 was studied in Pelotas, a city in southern Brazil. A standardized questionnaire on asthma was given to the children's mothers. Information was also collected on socioeconomic level, housing conditions, genetic factors, nutritional factors, and previous infectious diseases. Current asthma (asthma diagnosed by a doctor during previous 12 months) and current wheeze (presence of wheezing during previous 12 months) were the main outcomes. The prevalence of current asthma was 18.4%, and current wheeze was 21.1%. The data were analyzed by multiple Poisson regression, and the risk factors that remained significant for both "current asthma and current wheeze" were, respectively, nonwhite color (RR = 1.41 and RR = 1.36), low maternal schooling (RR = 1.75 and RR = 1.68 for 0-4 years), history of asthma or allergy in the family (RR = 1.66 and RR = 1.85), and history of rhinitis and eczema in the child (RR = 2.11 and RR = 1.72). Male sex (RR = 1.36) and bronchiolitis (RR = 1.46) were major risk factors only for "current asthma," while smoking in pregnancy (RR = 1.30) and low birth weight (RR = 1.45) were risk factors only for "current wheeze." These results highlight the importance of asthma as a public health problem due to its high prevalence, and support the need of intervention programs against preventable risk factors.     

Differences in prevalence of asthma, rhinitis, and eczema between parental and self-completed questionnaires in adolescents

This study was undertaken to compare, for the first time in a developing country, the prevalence of asthma, rhinitis, and eczema in children aged 13-14 years when questionnaires from the International Study of Asthma and Allergies in Childhood (ISAAC) were independently completed by children and parents. A random sample of 3,178 children completed the ISAAC questionnaire at school, while in another sample of 3,387 children, the questionnaire was completed by their parents at home. The prevalence of asthma, rhinitis, and eczema symptoms was significantly higher when questionnaires were completed by adolescents themselves rather than by the parents, particularly for those symptoms that could be better perceived by children or that were more severe, e.g., wheezing with exercise, severe episodes of wheezing, nocturnal cough, and awaking with wheezing in the last 12 months. The diagnosis of hay fever and eczema was also reported more frequently by adolescents compared to their parents. The prevalence of asthma ever and wheezing in the last 12 months was not significantly different between the two samples. In a randomly selected subset of 550 pairs where adolescents and parents came from the same family, asthma ever had the highest agreement (kappa = 0.72, 95% CI: 0.64-0.80), but agreement was poor for rhinitis and eczema ever. In conclusion, the prevalence of asthma, rhinitis, and eczema symptoms varied according to whether the information was reported by independent samples of adolescent or parents. However, the prevalence of wheezing in the last 12 months and asthma ever was quite similar between adolescents and parents, suggesting that these questions are crucial for assessing asthma in epidemiological studies.     

Early farm residency and prevalence of asthma and hay fever in adults

Background: Asthma and hay fever have been found to be both positively and negatively associated with farming lifestyles in adulthood. Lack of congruency may depend upon early life exposure. Objective: To assess the importance of different periods of farm residency for asthma and hay fever in an adult Canadian population. Methods: We conducted a questionnaire survey in rural Saskatchewan, Canada. We assessed a history of asthma and hay fever with five categories of farm residency that were mutually exclusive: first year of life only, currently living on a farm, both first year of life and currently living on a farm, other farm living, and no farm living. Generalized estimating equations were used to adjust for clustering effects of adults within households. Results: Of the 7148 responding, 30.6% had an early farm living experience only, 34.4% had both early and current farm living experiences, while 17.4% had never lived on a farm. The overall prevalence of ever asthma and hay fever was 8.6% and 12.3%, respectively, and was higher in women. Sex modified the associations between ever asthma and hay fever with farm residency variables whereby women had a decreased risk for both asthma [adjusted odds ratio (OR_adj): 0.67, 95% confidence interval (CI):0.47–0.96] and hay fever (OR_adj: 0.60, 95% CI: 0.44–0.83) with an early farm exposure only. Men currently living on a farm without an early farm exposure had an increased risk for ever asthma (OR_adj: 1.82, 95% CI: 1.02–3.24). Conclusion: Farm residency in the first year of life shows a protective effect for adult asthma and hay fever that appears to differ by sex.     

Nationwide survey of prevalence and risk factors of prehypertension and hypertension in Iranian adults

OBJECTIVE: The aim of this study was to estimate the prevalence and risk factors of prehypertension (Pre-HTN) and hypertension (HTN) among the adult population of Iran. METHODS: A nationwide cross-sectional survey was conducted from December 2004 to February 2005. The selection was conducted by stratified probability cluster sampling through household family members in Iran. Blood pressure (BP) and associated risk factors of 35 048 men and 34 674 women aged 25-65 years (mean 44.1 years) were measured. RESULTS: The prevalence of Pre-HTN was 59.6% in men and 44.5% in women; and 19.8% of men and 26.9% of women were hypertensive, according to Joint National Committee 7 criteria. Pre-HTN was more common among men whereas HTN was more common among women. Multivariate analysis revealed that age, overweight, obesity, abdominal obesity and high cholesterol were strongly associated with Pre-HTN in both genders. In women, low educational attainment, residence in an urban area and high blood glucose were also associated with Pre-HTN. Age, low educational attainment, overweight, obesity, abdominal obesity and high cholesterol and blood glucose were strongly associated with HTN in both genders. CONCLUSION: Pre-HTN and HTN appear to be quiet common in Iran and were associated with obesity. More men than women present with Pre-HTN, whereas more women than men present with HTN. Prevention and treatment strategies are urgently needed to address the health burden of Pre-HTN and HTN and to prevent prehypertensive people from developing HTN and cardiovascular disease.     

Hyperlipidemia in Iranian liver transplant recipients: prevalence and risk factors

Background Hyperlipidemia is a metabolic complication after liver transplantation (LT). The aim of this study was to investigate the prevalence and risk factors for developing hyperlipidemia in patients who underwent LT in the Shiraz Organ Transplantation Center. Methods Our patients were 170 liver recipients who underwent LT from 1994 to 2006 in the Organ Transplantation Center of the Shiraz University of Medical Sciences. To perform this study we administered questionnaires, including information about age, sex, body mass index (BMI), underlying liver disease, graft type, immunosuppressive medications, and serum levels of triglycerides and cholesterol, before and 6 months after LT. Serum triglyceride and cholesterol levels were considered elevated if they were >150 mg/dl and >250 mg/dl, respectively. Data were analyzed with SPSS software. Results There were 108 male and 62 female patients, with a mean age of 31.4 ± 13.3 years, and the mean duration of follow-up was 25.9 ± 23.5 months. The average pretransplant serum triglyceride and cholesterol (mean of individual means) levels were 104.6 ± 73.2 and 109.5 ± 51.5 mg/dl, respectively, and the average posttransplant levels were 230.1 ± 131 and 185 ± 77 mg/dl, respectively. Six months after LT, 119 (70%) and 26 (15.3%) patients developed hypertriglyceridemia and hypercholesterolemia, respectively. Age, sex, BMI, and underlying liver disease were not predictors of hypertriglyceridemia or hypercholesterolemia (P > 0.05). Posttransplant hypertriglyceridemia was significantly more common in patients receiving tacrolimus than in those receiving cyclosporine (P = 0.040), but posttransplant hypercholesterolemia had no significant correlation with type of immune suppression (P > 0.05). Conclusions Hyperlipidemia was common after LT, and hypertriglyceridemia was more common than hypercholesterolemia. Among all risk factors, tacrolimus therapy was correlated with development of hypertriglyceridemia after LT.     

Occupations with an increased prevalence of self-reported asthma in Indian adults

Objectives: Occupational asthma remains relatively under-recognized in India with little or no information regarding preventable causes. We studied occupations with an increased prevalence of self-reported asthma among adult men and women in India. Methods: Analysis is based on 64?725 men aged 15–54 years and 52?994 women aged 15–49 years who participated in India’s third National Family Health Survey, 2005–2006, and reported their current occupation. Prevalence odds ratios (ORs) for specific occupations and asthma were estimated using multivariate logistic regression, separately for men and women, adjusting for age, education, household wealth index, current tobacco smoking, cooking fuel use, rural/urban residence and access to healthcare. Results: The prevalence of asthma among the working population was 1.9%. The highest odds ratios for asthma were found among men in the plant and machine operators and assemblers major occupation category (OR: 1.67; 95% CI: 1.14–2.45; p?=?0.009). Men working in occupation subcategories of machine operators and assemblers (OR: 1.85; 95% CI: 1.24–2.76; p?=?0.002) and mining, construction, manufacturing and transport (OR: 1.33; 95% CI: 1.00–1.77; p?=?0.051) were at the highest risk of asthma. Reduced odds of asthma prevalence in men was observed among extraction and building trades workers (OR: 0.72; 95% CI: 0.53–0.97; p?=?0.029). Among women none of the occupation categories or subcategories was found significant for asthma risk. Men and women employed in high-risk occupations were not at a higher risk of asthma when compared with those in low-risk occupations. Conclusions: This large population-based, nationally representative cross-sectional study has confirmed findings from high income countries showing high prevalence of asthma in men in a number of occupational categories and subcategories; however, with no evidence of increased risks for women in the same occupations.     

The prevalence of asthma in Victorian adults

To determine the prevalence of asthma in Victorian adults, we carried out a cross-sectional postal survey utilising a new screening questionnaire which gathered data on self reported respiratory symptoms, whether asthma had been diagnosed and, if so, how it had been treated. Questionnaires were returned by 2198 (72%) of 3095 adults selected randomly from the Victorian electoral roll, an adequate response rate. The reported prevalences of individual asthmatic symptoms in the last 12 months ranged from 8% for nocturnal wheeze to 22% for current wheeze. Thirteen per cent of respondents had ever had asthma, 7% had experienced an attack within the last 12 months and 6% were currently taking medication.
The high prevalence of asthma revealed by our study has major implications for the planning of health services.