Altitude above 1500 m is a major determinant of asthma incidence. An ecological study.

Abstract

Previous studies suggest an inverse correlation between asthma and altitude. In the present work, we performed an in-depth analysis of asthma incidence in the 758 Mexican counties covered by the largest medical institution in the country (∼37.5 million insured subjects), and evaluated its relationships with altitude and other factors. Asthma incidence in each county was calculated from new cases diagnosed by family physicians. Other variables in the same counties, including selected diseases, geographical variables, and socioeconomic factors, were also obtained and their association with asthma was evaluated through bivariate and multivariate analyses. Median asthma incidence was 296.2 × 100,000 insured subjects, but tended to be higher in those counties located on or near the coast. When asthma incidence was plotted against altitude, a two-stage pattern was evident: asthma rates were relatively stable in counties located below an altitude of ∼1500 m, while these rates progressively decreased as altitude increased beyond this level (rS = -0.51, p < .001). Multivariate analysis showed that, once each variable was adjusted by the potential influence of the others, asthma incidence was inversely correlated with altitude (standardized β coefficient, -0.577), helminthiasis (-0.173), pulmonary tuberculosis (-0.130), and latitude (-0.126), and was positively correlated with acute respiratory tract infection (0.382), pneumonia (0.289), type 2 diabetes (0.138), population (0.108), and pharyngotonsillitis (0.088), all with a p ≤ .001. Our study showed that altitude higher than ∼1500 m comprises a major factor in determining asthma incidence, with the risk of new-onset asthma decreasing as altitude increases. Other less influential conditions were also identified.