哮喘联盟

   摘要
   背景和目的：深刻理解贫穷相关的家庭困境如何影响儿童健康，有助于明确可供治疗目标。烟草烟雾暴露可能是困难家庭的儿童所要面临的问题之一。此研究旨在利用测定哮喘住院儿童烟草代谢产物可替宁的血清浓度，探讨家庭困境与烟草烟雾暴露的关联。
   方法：我们前瞻性的招募774例年龄为1～16岁，入院诊断为哮喘或支气管扩张及反应性喘鸣的儿童。主要观察指标为可替宁的血清浓度。通过利用11个经济和社会变量，对受试儿童的照料者进行调查，评估儿童家庭的困难程度。利用logistic回归分析评估家庭困难和检测出的可替宁血清浓度之间的关联。
   结果：实验获得675 例儿童的完整研究数据，其中57%的儿童为非裔美国人，74%的儿童加入Medicaid医保项目。共有56%的儿童被检测出血清中含有可替宁。80%以上的受试家庭报告有一个或一个以上困难，41%以上的受试家庭报告有四个或四个以上困难。儿童被检测出血清中含有可替宁的机率，随着家庭困难数量的增多而上升。调整后的分析显示，家庭有四个或四个以上困难的儿童血清中被检测出可替宁的比率，是没有家庭困难的儿童的3.7倍（95%可信区间 （CI），2.0-7.0）。父母较低的收入和受教育程度也和儿童血清中检测出的可替宁事件呈独立相关。
   结论：家庭困难和血清中的可替宁常与儿童哮喘发病相关。由此可知，干预家境困难和烟草烟雾暴露，可能会减小儿童健康方面的差距。
 

（苏欣 审校）
Pediatrics. 2015 Jan 12. pii: peds.2014-1748. [Epub ahead of print]


 

Family Hardships and Serum Cotinine in Children With Asthma.
 

Spanier AJ1, Beck AF2, Huang B2, McGrady ME2, Drotar DD2, Peake RW3, Kellogg MD3, Kahn RS2.
 

Abstract
BACKGROUND AND OBJECTIVE: A better understanding of how poverty-related hardships affect child health could highlight remediable intervention targets. Tobacco smoke exposure may be 1 such consequence of family hardship. Our objective was to explore the relationship between family hardships and tobacco exposure, as measured by serum cotinine, a tobacco metabolite, among children hospitalized for asthma.
METHODS: We prospectively enrolled a cohort of 774 children, aged 1 to 16 years, admitted for asthma or bronchodilator-responsive wheezing. The primary outcome was detectable serum cotinine. We assessed family hardships, including 11 financial and social variables, through a survey of the child's caregiver. We used logistic regression to evaluate associations between family hardship and detectable cotinine.
RESULTS: We had complete study data for 675 children; 57% were African American, and 74% were enrolled in Medicaid. In total, 56% of children had detectable cotinine. More than 80% of families reported ≥1 hardship, and 41% reported ≥4 hardships. Greater numbers of hardships were associated with greater odds of having detectable cotinine. Compared with children in families with no hardships, those in families with ≥4 hardships had 3.7-fold (95% confidence interval, 2.0-7.0) greater odds of having detectable serum cotinine in adjusted analyses. Lower parental income and educational attainment were also independently associated with detectable serum cotinine.
CONCLUSIONS: Family hardships are prevalent and associated with detectable serum cotinine level among children with asthma. Family hardships and tobacco smoke exposure may be possible targets for interventions to reduce health disparities.
 

Pediatrics. 2015 Jan 12. pii: peds.2014-1748. [Epub ahead of print]