2001年、2011年和 2016年臺灣中學生氣喘、過敏性鼻炎和異位性皮膚炎盛行率趨勢

Abstract

背景：氣喘是最常見的過敏性疾病，特別是在兒童中。在過去的20年裡，氣喘在一些國家的發病率有所下降，而在另一些國家則有所增加。過敏性鼻炎（AR）影響了世界上10%到40%的人口，臺灣亦有類似的罹患情形。異位性皮膚炎（AD）是一種孩童常見的發炎性皮膚病。它也會在家庭和社會中產生一定的經濟負擔。在21世紀的亞洲，醫生診斷的AD的1年罹患率為0.96%至22.6%的兒童。臺灣亦有類似的罹患情形。 研究目的：本研究旨在通過過去20年對全臺灣中學生的一系列橫斷面研究，觀察氣喘、過敏性鼻炎和異位性皮膚炎的流行趨勢並探討相關之因子。 研究方法：本研究使用中文版的兒童哮喘和過敏症國際研究（ISAAC）問卷，在2001年、2011年和2016年對全臺灣12-15歲的中學生進行了全國性的橫斷面研究。我們選擇問卷調查前7年的空氣污染物資料與氣候因子資料，這些資料來自於學校方圓5公裡內環境保護署（Environmental Protection Agency, EPA）的監測站。我們將醫生診斷的氣喘、過敏性鼻炎、異位性皮膚炎作為結果，將環境因素作為因變數，廣義估計方程（Generalized Estimating Equation, GEE）控制協同變量，並進行統計分析。在得出結果後，將三年的結果用meta-analysis進行整合。 研究結果：對過敏性疾病來說，2001-2016年臺湾的氣喘症呈上升趨勢，2011年後有所下降。過敏性鼻炎患者近期有所增加，異位性皮膚炎则没有什麼區别。同時，空氣污染物如SO2、NO、CO、PM10和PM2.5在過去20年中呈現出先增後減的總體趨勢，而O3一直在減少。在過去20年中，年平均環境温度上升了將近1℃。進一步meta-analysis研究發现，每增0.1 ppm的CO與每增1度環境溫度對孩童氣喘症盛行率的OR分別為1.04（95% CI：1.02-1.06）、0.90（95% CI：0.83-0.98）；每增0.1 ppm的CO、每增1 ppb的NO、每增1 ppb的NO2對孩童過敏性鼻炎盛行率的OR分別為1.02（95% CI：1.01-1.03）、1.004（95% CI：1.002-1.005）、1.011（95% CI：1.006-1.016）。這些空氣污染物與氣候因子對孩童異位性皮膚炎的盛行率則無統計上的顯著影響。 研究結論：結合三次的研究調查後，孩童氣喘症與過敏性鼻炎盛行率與交通源的空氣污染有相關。孩童的氣喘盛行率會受到溫度的影響。異位性皮膚炎则與空氣污染物或氣候因子無顯著相關。

BACKGROUND: Asthma is the most prevalent allergic disease, particularly among children of school age. In some countries, asthma has decreased over the past two decades, while it has increased in others. Allergic rhinitis (AR) affects between 10 and 40 percent of the world's population. The prevalence of AR is comparable. Atopic dermatitis (AD) is a prevalent inflammatory skin condition in childhood, causing significant financial burden on health expenditure and society. In Asia in the 21st century, the 1-year prevalence of AD diagnosed by a physician ranged from 0.96 to 22.6% in children. In Taiwan, the prevalence of AD was similar. STUDY AIMS: The purpose of this study was to observe the prevalence and determine the associated effects of asthma, allergic rhinitis, and atopic dermatitis through a series of cross-sectional studies of secondary school students throughout Taiwan over the past 20 years. METHODS: This study used the Chinese version of the International Study of Asthma and Allergies in Children (ISAAC) questionnaire to conduct a cross-sectional study of secondary school pupils in Taiwan in 2001, 2011, and 2016. We gathered air pollutant and climate factor data from Environmental Protection Agency (EPA) monitoring stations within a 5-kilometer radius of the school for the seven years preceding the survey. We used asthma, allergic rhinitis, and atopic dermatitis diagnosed by a physician as outcomes, environmental factors as dependent variables, and generalized estimating equations (GEE) to control for co-variates and statistical analyses. After obtaining the findings, the three-year results were combined using meta-analysis. RESULTS: Regarding allergic diseases, Taiwan's asthma trend increased from 2001 to 2016 before declining after 2011. Patients with allergic rhinitis have increased recently, while those with atopic dermatitis have shown little change. During the same period, air pollutants such as SO2, NO, CO, PM10, and PM2.5 increased and decreased over the past 20 years, while O3 decreased. Over the past two decades, the annual average ambient temperature has increased by approximately 1°C. Meta-analysis of the three cross-sectional studies showed that for life-time prevalence of asthma, the ORs of per 0.1 ppm increment of CO and 1 degree of ambient temperature were 1.04 (95% CI: 1.02-1.06) and 0.90 (95% CI: 0.83-0.98), respectively. For AR, the ORs of per 0.1 ppm increment of CO, per 1 ppb increment of NO, and per 1 ppb increment of NO2 were 1.02 (95% CI: 1.01–1.03), 1.004 (95% CI: 1.002-1.005), and 1.011 (95% CI: 1.006–1.005), respectively. AD was not associated with air pollutants and climate factors. CONCLUSIONS: From the three cross-sectional studies, ttraffic-related air pollutants were related to the occurrence of asthma and allergic rhinitis in children, but not atopic dermatitis.