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Original Research: Asthma |

Associations of Early Life Exposures and Environmental Factors With Asthma Among Children in Rural and Urban Areas of Guangdong, China

Mulin Feng, MD; Zhaowei Yang, PhD; Liying Pan, MD; Xuxin Lai, PhD; Mo Xian, MD; Xiafei Huang, MD; Yan Chen, MD; Paul C. Schröder, PhD; Marjut Roponen, PhD; Bianca Schaub, MD; Gary W.K. Wong, MD; Jing Li, MD
Author and Funding Information

Drs Feng and Yang contributed equally to the work described in this paper.

FUNDING/SUPPORT: This study was funded by the International (Regional) Cooperation and Exchange Program [Cooperation Research-NSFC-AF-DFG] of the National Natural Science Foundation of China [81261130023] to J. L., the Academy of Finland [grant 256375] to M. R., the Hong Kong Research Grants Council [CUHK 477110] to G. W. K. W., and the German Research Foundation [DFG, SCHA 997/3-1] to B. S.

CORRESPONDENCE TO: Jing Li, MD, Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, No. 151, Yanjiangxi Rd, Guangzhou, 510120 China


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(4):1030-1041. doi:10.1016/j.chest.2015.12.028
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Background  Environmental factors may play important roles in asthma, but findings have been inconsistent.

Objective  The goal of this study was to determine the associations between early life exposures, environmental factors, and asthma in urban and rural children in southeast China.

Methods  A screening questionnaire survey was conducted in 7,164 children from urban Guangzhou and 6,087 from rural Conghua. In the second stage, subsamples of 854 children (419 from Guangzhou, 435 from Conghua) were recruited for a case-control study that included a detailed questionnaire enquiring on family history, early life environmental exposures, dietary habits, and laboratory tests (including histamine airway provocation testing, skin prick tests, and serum antibody analyses). House dust samples from 76 Guangzhou families and 80 Conghua families were obtained to analyze levels of endotoxins, house dust mites, and cockroach allergens.

Results  According to the screening survey, the prevalence of physician-diagnosed asthma was lower in children from Conghua (3.4%) than in those from Guangzhou (6.9%) (P < .001). A lower percentage of asthma was reported in rural subjects compared with urban subjects (2.8% vs. 29.4%; P < .001) in the case-control study. Atopy (OR, 1.91 [95% CI, 1.58-2.29]), parental atopy (OR, 2.49 [95% CI, 1.55-4.01]), hospitalization before 3 years of age (OR, 2.54 [95% CI, 1.37-4.70]), high consumption of milk products (OR, 1.68 [95% CI, 1.03-2.73]), and dust Dermatophagoides farinae group 1 allergen (OR, 1.71 [95% CI, 1.34-2.19]) were positively associated with asthma. Living in a crop-farming family at < 1 year of age (OR, 0.15 [95% CI, 0.08-0.32]) and dust endotoxin levels (OR, 0.69 [95% CI, 0.50-0.95]) were negatively associated with asthma.

Conclusions  Rural children from an agricultural background exhibited a reduced risk of asthma. Early life exposure to crop farming and high environmental endotoxin levels might protect the children from asthma in southern China.

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