Environmental risk factor assessment: a multilevel analysis of childhood asthma in China

Fei Li, Ying-Chun Zhou, Shi-Lu Tong, Sheng-Hui Li, Fan Jiang, Xing-Ming Jin, Chong-Huai Yan, Ying Tian, Shi-Ning Deng, Xiao-Ming Shen

Shanghai, China

Author Affiliations: Department of Developmental and Behavioral Pediatrics, Shanghai Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China (Li F, Jiang F, Jin XM, Deng SN, Shen XM); Shanghai Key Laboratory of Children's Environmental Health, Shanghai Jiaotong University School of Medicine Shanghai, China (Li F, Li SH, Jiang F, Jin XM, Yan CH, Tian Y, Deng SN, Shen XM); The Key Laboratory of Children's Environmental Health, Ministry of Education, China (Li F, Li SH, Jiang F, Jin XM, Yan CH, Tian Y, Deng SN, Shen XM); Department of Statistics and Actuarial Sciences, East China Normal University, China (Zhou YC); School of Public Health and Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia (Tong SL)

Corresponding Author: Xiao-Ming Shen, MD, 1678 Dongfang Road, Shanghai 200129, China (Tel: 86-21-38626161-6020; Fax: 86-21-38626161-6020; Email: xmshen@shsmu.edu.cn)

doi: 10.1007/s12519-013-0413-5

Background: Rapid changes in socioeconomic environ-ment and their diverse patterns in China raise a question: how socio-environmental factors affect childhood asthma in China. We performed a multilevel analysis based on a 2005 national survey to understand the association between environmental factors and asthma, and to provide insights on developing prevention strategies.

Methods: A multi-center, cross-sectional survey was conducted in 2018 school-aged children chosen from eight Chinese cities. Children of 6-13 years old were chosen randomly from schools of 39 centers in 8 cities. The multilevel analysis was made to assess both individual-level and city-level risk factors. The effect of gross domestic product (GDP) was further investigated by analysis of the factors.

Results: Analysis of city-level environmental factors showed that GDP [adjusted odds ratio (OR)=1.88], particulate matter with aerodynamic diameter ≤10 μm (PM₁₀) (adjusted OR=1.37), and average humidity (adjusted OR=1.33) were strong risk factors. Further analysis of the factors decomposed GDP into two major factors, the first represented by urban construction, energy consumption, nitrogen dioxide concentration, and the second represented by health-system coverage. This suggested that the negative effects of GDP outweighed its positive effects on asthma.

Conclusions: The prevalence of childhood asthma varies significantly in the eight Chinese cities. Socio-environmental factors such as GDP, PM₁₀ and average humidity are strong risk factors controlling individual attributes, suggesting that balance is needed between public health and economic development in China.

Key words: asthma; environmental health; risk factors; socioeconomic factors

World J Pediatr 2013;9(2):120-126