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Socioeconomic status, asthma and chronic bronchitis in a large community-based study

L. Ellison-Loschmann, J. Sunyer, E. Plana, N. Pearce, J-P. Zock, D. Jarvis, C. Janson, J. M. Antó, M. Kogevinas
European Respiratory Journal 2007 29: 897-905; DOI: 10.1183/09031936.00101606
L. Ellison-Loschmann
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J. Sunyer
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E. Plana
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N. Pearce
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J-P. Zock
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D. Jarvis
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C. Janson
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J. M. Antó
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M. Kogevinas
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    Fig. 1—

    Selection of the study population for the European Community Respiratory Health Survey (ECRHS) II socioeconomic status, asthma and chronic bronchitis study. SOB: shortness of breath.

Tables

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  • Table 1—

    Characteristics of participants in the European Community Respiratory Health Survey II(1999–2001)#

    Individual variablesSubjectsRange by centre %
    Sex
     Male3412 (49.0)41.3–54.4
     Female3553 (51.0)45.6–58.7
    Age yrs43.0±7.139.2–46.7
    BMI kg·m−2
     <20390 (5.7)1.1–12.3
     ≥20–<253096 (45.6)31.3–60.9
     ≥25–<302429 (35.8)25.8–45.3
     ≥30879 (12.9)3.1–29.8
    Family history of asthma808 (11.6)5.7–19.2
    Smoking status
     Never-smoker2927 (42.0)30.2–60.7
     Former smoker1945 (27.9)6.5–40.7
     Current smoker2027 (29.1)11.9–48.2
    Exposure to ETS2637 (38.0)18.9–78.2
    Siblings
     0690 (9.9)0.9–21.3
     12121 (30.5)12.3–48.7
     ≥24134 (59.5)31.4–79.8
    Respiratory infections before 5 yrs of age689 (9.9)2.2–16.3
    Rhinitis2051 (29.5)11.1–43.0
    High occupational exposure to biological or mineral dust, gas or fumes991 (14.6)5.0–27.6
    Mould or mildew in home in previous 12 months1166 (16.7)2.2–40.7
    Outcome variables
     Asthma725 (10.4)4.9–15.9
      With atopy372 (5.3)1.3–11.8
      Without atopy353 (5.1)2.2–9.7
     Atopy without asthma1646 (23.6)13.4–33.9
     No asthma nor atopy4594 (66.0)52.6–81.7
     Chronic bronchitis¶247 (3.0)0.0–8.5
     Asthma score0.66±1.20.36–0.96
    Socioeconomic status measures
     Occupational class+
      I2096 (30.1)15.1–49.7
      II1246 (17.9)7.5–28.2
      III1791 (25.7)15.5–40.2
      IV695 (10.0)2.2–18.5
      V655 (9.4)2.8–19.0
      VI482 (6.9)1.3–17.5
     Educational level (country-specific tertiles)
      High1883 (28.4)17.8–37.3
      Medium2101 (31.7)10.9–48.0
      Low2650 (39.9)29.5–63.8
    • Data are presented as n (%) or mean±sd, unless otherwise stated. BMI: body mass index; ETS: environmental tobacco smoke. #: only subjects with serum immunoglobulin E measurements were included (n = 6,965); ¶: chronic bronchitis category (n = 7,915); +: I for managers and professionals, II for technicians and associate professionals, III for other nonmanual workers, IV for skilled manual workers, V for semi-skilled/unskilled manual workers and VI for unclassifiable/unknown.

  • Table 2—

    Prevalence odds ratios(POR) of asthma (with or without atopy) and chronic bronchitis in European Community Respiratory Health Survey II participants by occupational class and education level

    POR (95%CI)
    AsthmaAsthma with atopyAsthma without atopyChronic bronchitis
    Subjects n6965#201849477915¶
    Minimally adjusted+
     Occupational class§
      Iƒ1111
      II1.16 (0.91–1.47)1.15 (0.82–1.60)1.10 (0.77–1.57)1.43 (0.94–2.17)
      III1.26 (1.01–1.56)1.15 (0.83–1.60)1.44 (1.06–1.95)1.71 (1.17–2.51)
      IV–V1.07 (0.83–1.36)0.91 (0.63–1.30)1.26 (0.89–1.79)1.84 (1.23–2.74)
      VI1.37 (1.00–1.88)1.07 (0.67–1.72)1.55 (1.00–2.41)1.62 (0.97–2.69)
     Educational level
      Highƒ1111
      Medium1.02 (0.82–1.26)0.74 (0.54–1.00)1.39 (1.01–1.93)1.54 (1.05–2.25)
      Low1.19 (0.93–1.43)0.93 (0.70–1.25)1.70 (1.26–2.29)1.93 (1.35–2.76)
    Fully adjusted##
     Occupational class§
      Iƒ1111
      II1.13 (0.88–1.42)1.08 (0.75–1.54)1.13 (0.78–1.65)1.43 (0.91–2.23
      III1.25 (0.99–1.57)1.22 (0.87–1.72)1.34 (0.97–1.85)1.53 (1.01–2.34)
      IV–V1.08 (0.78–1.48)0.91 (0.57–1.46)1.20 (0.77–1.88)1.66 (0.96–2.87)
      VI1.25 (0.84–1.86)1.16 (0.63–2.14)1.28 (0.75–2.19)1.24 (0.56–2.75)
     Educational level
      Highƒ1111
      Medium1.02 (0.81–1.28)0.75 (0.53–1.05)1.40 (1.00–1.97)1.59 (1.04–2.42)
      Low1.20 (0.95–1.52)1.10 (0.79–1.52)1.55 (1.18–2.14)1.66 (1.10–2.50)
    • CI: confidence interval. #: Only subjects with serum immunoglobulin E measurements were included (except bronchitis category); ¶: excludes Tartu (Estonia) centre; +: for age, sex and centre; §: I for managers and professionals, II for technicians and associate professionals, III for other nonmanual workers, IV for skilled manual workers, V for semi-skilled/unskilled manual workers and VI for unclassifiable/unknown; ƒ: reference category; ##: for age, sex, country, body mass index, family history of asthma, number of siblings, exposure to environmental tobacco smoke, smoking status, respiratory infections before 5 yrs of age, mould or mildew in the home in the previous 12 months, rhinitis and high occupational exposure to pollutants.

  • Table 3—

    Cumulative incidence of respiratory symptoms and sensitisation and asthma score by occupational class and education level between European Community Respiratory Health Survey I(1991–1992) and II (1999–2001)#

    VariableOccupational class¶Education
    IIIIIIIV–VVIp-value+HighMediumLowp-value+
    Asthma symptom
     Breathless while wheezing in previous 12 months1.41.11.41.60.5<0.0011.51.62.90.004
     Waking with chest tightness in previous 12 months2.51.62.31.80.80.3062.32.53.90.032
     Attack of shortness of breath at rest in previous 12 months0.90.61.10.60.40.1411.01.01.60.248
     Attack of shortness of breath after exercise in previous 12 months3.92.54.53.21.20.0013.64.27.3<0.001
     Waking due to attack of shortness of breath in previous 12 months0.90.71.00.60.40.0710.91.31.60.345
     Asthma ever1.00.81.00.70.30.5531.11.21.70.428
     Asthma score mean0.240.360.360.350.38<0.001§0.280.290.38<0.001§
     Asthma1.31.01.50.90.50.0621.21.72.40.087
    Other symptoms
     Bronchitis0.20.30.40.30.20.1480.20.50.70.008
    Sensitisation
     Dermatophagoides pteronyssinus4.42.52.82.81.10.0093.94.64.60.028
     Cat2.11.51.51.20.40.1862.02.22.30.308
     Grass4.42.93.42.70.90.2654.54.55.00.034
     Cladosporium herbarium0.30.10.10.20.040.5090.20.20.30.592
    • Data are presented as % of new cases, unless otherwise stated. #: Only subjects with serum immunoglobulin E measurements were included (except bronchitis category); ¶: I for managers and professionals, II for technicians and associate professionals, III for other nonmanual workes, IV for skilled manual workers, V for semi-skilled/unskilled manual workers and VI for unclassifiable/unknown; +: from Chi-squared test for association with categorical variables; §: p-value from likelihood ratio test for asthma score.

  • Table 4—

    Cumulative incidence risk ratios(RR) of asthma (with or without atopy) bronchitis and asthma score for European Community Respiratory Health Survey II participants by occupational class and education level

    RR (95% CI)IRR (95% CI)
    AsthmaAsthma with atopyAsthma without atopyBronchitisAsthma score
    Subjects n5645#140642396455¶5924+
    Minimally adjusted§
     Occupational classƒ
      I##11111
      II1.23 (0.90–1.67)1.47 (0.88–2.47)1.16 (0.74–1.81)1.72 (0.87–3.41)1.36 (1.12–1.64)
      III1.18 (0.89–1.57)1.13 (0.67–1.91)1.20 (0.81–1.78)1.97 (1.04–3.74)1.40 (1.18–1.67)
      IV–V1.11 (0.81–1.52)0.81 (0.44–1.50)1.23 (0.83–1.83)1.95 (0.98–3.88)1.43 (1.19–1.73)
      VI1.05 (0.72–1.56)1.48 (0.75–2.92)1.31 (0.76–2.27)2.20 (0.97–4.96)1.32 (1.04–1.67)
     Educational level
      High##1111
      Medium1.21 (0.89–1.65)0.91 (0.57–1.47)1.44 (0.95–2.17)2.15 (1.10–4.23)1.08 (0.92–1.28)
      Low1.32 (0.99–1.77)1.13 (0.72–1.78)1.53 (1.04–2.25)2.83 (1.48–5.41)1.33 (1.14–1.56)
    Fully adjusted¶¶
     Occupational classƒ
      I##11111
      II1.25 (0.90–1.73)1.52 (0.91–2.56)1.16 (0.74–1.82)1.50 (0.75–3.03)1.33 (1.09–1.62)
      III1.08 (0.80–1.47)1.23 (0.73–2.08)1.20 (0.81–1.78)1.52 (0.77–3.01)1.38 (1.15–1.66)
      IV–V1.05 (0.69–1.60)0.76 (0.35–1.63)1.37 (0.79–2.39)1.37 (0.55–3.42)1.40 (1.09–1.80)
      VI1.01 (0.61–1.70)1.36 (0.57–3.25)1.26 (0.66–2.42)2.23 (0.78–6.34)1.36 (0.98–1.89)
     Educational level
      High##11111
      Medium1.18 (0.86–1.63)0.93 (0.56–1.53)1.37 (0.90–2.09)2.13 (1.02–4.45)1.11 (0.93–1.33)
      Low1.40 (1.03–1.89)1.36 (0.85–2.17)1.50 (1.00–2.25)2.49 (1.21–5.13)1.31 (1.10–1.56)
    • CI : confidence interval; IRR: incidence RR. #: Only subjects with serum immunoglobulin E measurements were included (except bronchitis category). ¶: excludes Tartu (Estonia) and Bordeaux (France) centres; +: includes only people with asthma score 0 at baseline; §: for age, sex and centre; ƒ: I for managers and professionals, II for technicians and associate professionals, III for other nonmanual workers, IV for skilled manual workers, V for semi-skilled/unskilled manual workers and VI for unclassifiable/unknown; ##: reference category; ¶¶: for age, sex, country, body mass index, family history of asthma, number of siblings, exposure to environmental tobacco smoke, smoking status, respiratory infections before 5 yrs of age, mould or mildew in the home in the previous 12 months, rhinitis and high occupational exposure to pollutants.

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Socioeconomic status, asthma and chronic bronchitis in a large community-based study
L. Ellison-Loschmann, J. Sunyer, E. Plana, N. Pearce, J-P. Zock, D. Jarvis, C. Janson, J. M. Antó, M. Kogevinas
European Respiratory Journal May 2007, 29 (5) 897-905; DOI: 10.1183/09031936.00101606

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Socioeconomic status, asthma and chronic bronchitis in a large community-based study
L. Ellison-Loschmann, J. Sunyer, E. Plana, N. Pearce, J-P. Zock, D. Jarvis, C. Janson, J. M. Antó, M. Kogevinas
European Respiratory Journal May 2007, 29 (5) 897-905; DOI: 10.1183/09031936.00101606
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