每日步数与成人哮喘发病风险的时序关联研究
2025/04/06
摘要
背景：较高日行步数与多种慢性病风险降低相关，而体力活动增加可改善哮喘预后，但目前成人新发哮喘尚缺乏有效预防策略。
目的：探究客观体力活动（日行步数）对成人哮喘发病率的影响。
方法：基于“全民健康研究计划”（All of Us）回顾性队列，纳入年龄≥18岁且具备个人活动追踪器与电子健康记录（EHR）关联数据的参与者。哮喘定义为：≥2次ICD-9/10诊断编码且≥1次哮喘相关药物治疗记录。将活动监测开始前或6个月内确诊哮喘者归类为现患哮喘（prevalent asthma），监测6个月后确诊者归类为新发哮喘（incident asthma）。
结果：共8,360名参与者符合纳入标准。无哮喘组日均步数中位数为7,795步（95% CI: 5,879-9,921，n=7,700），显著高于现患哮喘组[6,968步（5,036-9,014，n=450）]及新发哮喘组[6,953步（5,215-8,261，n=210）]（p<0.0001）。时序分析显示，新发哮喘组日均步数随时间下降幅度更大（时间×哮喘发病交互作用p=0.018）。校正年龄、性别、种族、BMI、重度抑郁障碍、睡眠呼吸暂停及慢性阻塞性肺病后，日均步数每增加1,000步与新发哮喘风险呈负相关[校正风险比aHR=0.93（95% CI: 0.88-0.98）]。
结论：客观监测显示，新发哮喘成人群体日均步数显著偏低，提示提升体力活动或可作为可调控风险因素降低哮喘发病率。未来研究需对哮喘高危及患病人群进行体力活动的客观监测与干预评估。
Association of Daily Steps Over Time with Adult Asthma Incidence
Joshua C Halevi, Jeffrey Annis, Hiral Master, Basil M Kahwash, Evan L Brittain, Katherine N Cahill.
Abstract
BACKGROUND:Higher daily step counts is associated with reduced risk of many chronic diseases. Increased physical activity improves asthma outcomes. There are no known prevention strategies for adult incident asthma.
OBJECTIVE:To determine whether objective physical activity impacts adult asthma incidence.
METHODS:Participants in the All of Us Research Program retrospective cohort aged ≥ 18 years with linked personal activity tracker and electronic health record data met inclusion. Asthma was defined as two ICD-9/10 codes and ≥ 1 medication. Participants with an asthma diagnosis date before/within six months of activity monitor initiation were assigned prevalent asthma; participants diagnosed after six months of activity monitoring were assigned incident asthma.
RESULTS: 8,360 participants met inclusion. Median average steps/day were higher among asthma-free participants [7,795 (5,879-9,921, 95% CI), n=7,700] than participants with prevalent [6,968 (5,036-9,014, 95% CI), n=450] or incident asthma [6,953 (5,215-8,261), n=210] (p <0.0001). Significant time by incident asthma interaction was observed with a greater decline in steps/day over time in the incident asthma cohort (p=0.018). An inverse relationship was observed between average steps/day and asthma incidence after adjusting for age, sex, race, body mass index, major depressive disorder, sleep apnea, and chronic obstructive lung disease [adjusted hazard ratio 0.93 (0.88-0.98, 95% CI) per 1,000 average daily step increase].
CONCLUSION:Objectively measured daily steps are lower in adults who develop incident asthma and may represent a modifiable risk factor to reduce asthma incidence. Future studies should objectively monitor physical activity among adults at risk for and with asthma.
背景：较高日行步数与多种慢性病风险降低相关，而体力活动增加可改善哮喘预后，但目前成人新发哮喘尚缺乏有效预防策略。
目的：探究客观体力活动（日行步数）对成人哮喘发病率的影响。
方法：基于“全民健康研究计划”（All of Us）回顾性队列，纳入年龄≥18岁且具备个人活动追踪器与电子健康记录（EHR）关联数据的参与者。哮喘定义为：≥2次ICD-9/10诊断编码且≥1次哮喘相关药物治疗记录。将活动监测开始前或6个月内确诊哮喘者归类为现患哮喘（prevalent asthma），监测6个月后确诊者归类为新发哮喘（incident asthma）。
结果：共8,360名参与者符合纳入标准。无哮喘组日均步数中位数为7,795步（95% CI: 5,879-9,921，n=7,700），显著高于现患哮喘组[6,968步（5,036-9,014，n=450）]及新发哮喘组[6,953步（5,215-8,261，n=210）]（p<0.0001）。时序分析显示，新发哮喘组日均步数随时间下降幅度更大（时间×哮喘发病交互作用p=0.018）。校正年龄、性别、种族、BMI、重度抑郁障碍、睡眠呼吸暂停及慢性阻塞性肺病后，日均步数每增加1,000步与新发哮喘风险呈负相关[校正风险比aHR=0.93（95% CI: 0.88-0.98）]。
结论：客观监测显示，新发哮喘成人群体日均步数显著偏低，提示提升体力活动或可作为可调控风险因素降低哮喘发病率。未来研究需对哮喘高危及患病人群进行体力活动的客观监测与干预评估。
（中日友好医院呼吸与危重症医学科 李春晓 摘译 林江涛 审校）
（J Allergy Clin Immunol Pract. 2025 Feb;13(2):361-368.e2DOI: 10.1016/j.jaip.2024.10.013）
Association of Daily Steps Over Time with Adult Asthma Incidence
Joshua C Halevi, Jeffrey Annis, Hiral Master, Basil M Kahwash, Evan L Brittain, Katherine N Cahill.
Abstract
BACKGROUND:Higher daily step counts is associated with reduced risk of many chronic diseases. Increased physical activity improves asthma outcomes. There are no known prevention strategies for adult incident asthma.
OBJECTIVE:To determine whether objective physical activity impacts adult asthma incidence.
METHODS:Participants in the All of Us Research Program retrospective cohort aged ≥ 18 years with linked personal activity tracker and electronic health record data met inclusion. Asthma was defined as two ICD-9/10 codes and ≥ 1 medication. Participants with an asthma diagnosis date before/within six months of activity monitor initiation were assigned prevalent asthma; participants diagnosed after six months of activity monitoring were assigned incident asthma.
RESULTS: 8,360 participants met inclusion. Median average steps/day were higher among asthma-free participants [7,795 (5,879-9,921, 95% CI), n=7,700] than participants with prevalent [6,968 (5,036-9,014, 95% CI), n=450] or incident asthma [6,953 (5,215-8,261), n=210] (p <0.0001). Significant time by incident asthma interaction was observed with a greater decline in steps/day over time in the incident asthma cohort (p=0.018). An inverse relationship was observed between average steps/day and asthma incidence after adjusting for age, sex, race, body mass index, major depressive disorder, sleep apnea, and chronic obstructive lung disease [adjusted hazard ratio 0.93 (0.88-0.98, 95% CI) per 1,000 average daily step increase].
CONCLUSION:Objectively measured daily steps are lower in adults who develop incident asthma and may represent a modifiable risk factor to reduce asthma incidence. Future studies should objectively monitor physical activity among adults at risk for and with asthma.
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