OLIN-studiernas barn-kohorter Umeå september 2018 Eva Rönmark Folkhälsa och klinisk medicin, Umeå universitet och OLIN studierna, Region Norrbotten
Obstruktiv Lungsjukdom i Norrbotten (OLIN) - epidemiologiska studierom astma, allergi och KOL - pågår sedan 1985 - - ca 60 000 individer i åldrar > 7år Göteborg Norrbotten Stockholm Metoder - tvärsnittsstudier - longitudinelle studier - fall-kontroll studier - kliniska studier Resultat - 20 doktorsavhandlingar och ca 20 från samverkande projekt - >> 200 original articles - Sex doktorandprojekt pågår www.nll.se/olin www.facebook.com/olin-studierna - Fyra forskningslinjer; astma & allergi bland vuxna, astma & allergi bland barn, KOL, hälsoekonomi
Tre pediatriska kohorter Rekryterade med 10 års mellanrum Alla barn i klass 1 & 2 i Kiruna, Luleå och Piteå 7-8 år vid rekrytering Föräldraenkät och med tiden enkät besvarad av deltagarna Kliniska undersökningar ffa i Kiruna och Luleå
The OLIN pediatric cohorts Cohort I recruted In 1996 7-8 år PQ, n=3430 (97%) SPT, n=2148 (90%) IgE, n=228 11-12 år PQ, n= SPT, n=2027 (83%) IgE, n=845(78%) LF 19 år PQ, n=2861 (83%) SPT, n=1868 (76%) IgE, n=963 (89%) LF 27-28 år PQ, n=2291 (71%) Cohort II recruted in 2006 7-8 år PQ, n=2585 (97%) SPT, n=1700 (88%) 11-12 år PQ, n= SPT, n= 1657 (85%) IgE, n=696 (73%) 19 år PQ, n=2250 (87%) SPT, n=1340 (79%) IgE, n=598 (86%) LF Cohort III recruted In 2017 7-8 år PQ, n=2712 (89%) SPT, n=1805 (84%)
Utfallsmått Prevalens, trender Incidens, trender Remission Naturalförlopp Riskfaktorer Livskvalitet
Utfallsmått: Prevalens, trender Incidens, trender Remission Naturalförlopp Riskfaktorer Livskvalitet Sjukdomar/tillstånd: Astma Rhinit Eksem Födoämnesöverkänslighet/allergi Allergisk sensibilisering (pricktest, specifika IgE och komponenter)
Riskfaktorer/karakteristika - baserad på enkätdata (faktorer i barndom, hereditet, miljö, livsstilsfaktorer, rökning,...) - uppmätta trafikflöden vid hemadressen - allergenmätning i skolor och hem - trikloramin-exponeringsmätningar på mest besökta badhus - Kliniska undersökningar (IgE, IgE-komponenter, pricktest, lungfunktion, bronkiell hyperreaktivit, födoämnesprovokationer, ) - Livskvalitetsformulär
Några resultat
Agreement between parental and teenager reports of conditions Asthma Rhinitis 8.2% 8.8% 9.8% Parental reports Teenager reports Parental and teenager reports Eczema 9.2% 21.4% 19.7% Hedman, et al. J Clin Epidemiol 2010
Prevalence (%) of positive skin prick test in 7-8 y old children in 1996 and 2006 in Northen Sweden % 35 30 25 20 15 10 5 0 *** *** *** *** *** 1996 (Cohort I; born 1987-88) 2006, Cohort II; born 1997-98 2017, Cohort III; born 2008-09? Rönmark et al. Respir Med 1998; JACI 209
Prevalence of positive skin prick test from 7/8 to 19 years in Northern Sweden in a cohort followed longitudinally Rönmark et al Allergy 1999, JACI 2009 % 45 40 35 30 25 20 15 10 5 0 7-8 years 11-12 years 19 years
Trends in allergic sensitization by increasing age in two cohorts followed fron 7 to 19 years. 50 45 40 35 30 25 20 15 10 5 0 7-8 years 11-12 years 19 yrears Cohort I (borne 1987-88) Cohort II (borne 1997-98) Rönmark et al. JACI 2003 och 2009 Bunne et al. JACI in practice 2015
Early life risk factors in relation to the incidence of allergic sensitization to any allergen Incidence of any positive SPT from birth to 7-8 y, n=310 Incidence of any positive SPT from 7-8 to 11-12 y, n=153 Incidence of any positive SPT from 11-12 to 19 y, n=184 Risk factor OR (95%CI) OR (95%CI) OR (95%CI) Order among siblings* 0.8 (0.7-1.0) 1.0 (0.9-1.1) 0.9 (0.8-1.1) Cat or dog in childhood 0.7 (0.5-0.9) 0.8 (0.6-1.2) 0.8 (0.5-1.1) Urban area in childhood 1.9 (1.2-2.9) 0.7 (0.5-1.1) 1.7 (1.0-2.9) Family history of allergy 2.1 (1.6-2.8) 1.4 (1.0-1.9) 1.6 (1.1-2.3) Male sex 1.3 (1.0-1.7) 1.5 (1.1-2.1) 1.0 (0.7-1.4) *Numeric variable Analyzed by multiple multinomial logistic regression with negative reactions to all allergens at all measurements as reference category, n= 845 Rönmark et al Allergy 2017
% of physician-diagnosed asthma Prevalence and Severity of asthma among 7-8 y children in 1996 and 2006. Andersson et al. Pediatr Allergy Immunol 2010 Physician-diagnosed asthma increased from 5.7 to 7.4% 50 45 40 35 30 25 20 15 10 5 0 p=0.006 0 1 2 3 4 Asthma severity score 1996 2006 Asthma score based on: Current wheeze, daily asthma medication, disturbed sleep, speech-limiting wheeze, >12 episodes of wheeze during last 12 months
Different risk factors for allergic and nonallergic asthma in children. Risk in Odds ratio (OR) Variables Allergic asthma OR (95%CI) Non allergic asthma OR (95%CI) Male sex Asthma in family 1.3 3.0 (0.8-2.1) (1.8-4.8) 1.6 3.6 (1.0-2.5) (2.3-5.7) Dampness at home 1.4 (0.8-2.4) 1.8 (1.1-2.9) Mother smokes 1.2 (0.7-2.0) 1.6 (1.0-2.7) Cat or dog at home 0.6 (0.4-0.9) 0.8 (0.5-1.2) Breast feeding < 3months 1.0 (0.6-1.8) 1.9 (1.1-2.9) Rönmark et al. Allergy 1999
Remission and persistence of asthma followed from 7 to 19 years of age Andersson et al. Pediatrics 2013 41% 21% 38% Remission: Free from symptom and asthma medication the last 3 year at age 19 y. Persistent asthma: Symptoms or use of asthma medication at the age of 19 years and in at least 8 of the 9 previous surveys. Factors related to persistence: - allergic sensitization - more severe disease
Sammanfattning av OLIN studiernas barnkohorter Tre kohorter; rekryterade med 10 års mellanrum, identiska metoder Longitudinell studiedesign; observationstid från 7 till 28 år Kliniska undersökningar i stora urval Mycket högt deltagande i alla kohorter, både vid rekrytering och vid uppföljningar