Abstract
This study was prepared to identify and characterize potential factors associated with childhood asthma and wheeze in Chinese preschool-aged children. A comprehensive questionnaire was designed for children aged 3–6 years and their parents or guardians in Beijing and Tangshan from September to December 2020. The least absolute shrinkage and selection operator (LASSO) model was used to identify factors in a significant association with childhood asthma and wheeze, respectively. The LASSO model was internally validated using bootstrap resampling with 100 replications. A total of 9,529 questionnaires were certified as eligible for inclusion after stringent quality control. The prevalence of doctor-diagnosed childhood asthma and parent-reported wheeze was 2.8 and 6.2%, respectively. Factors simultaneously associated with childhood asthma and wheeze were children with a history of allergic rhinitis, hay fever, eczema, initial age of using antibiotics, body mass index category, and family history of asthma. Specifically, children's vitamin D supplement duration was significantly associated with childhood asthma, whereas the association with childhood wheeze was significant for intake frequency of night meals for children and their screen time. Modeling of significant factors in nomograms had decent prediction accuracies, with C-index reaching 0.728 and 0.707 for asthma and wheeze, respectively. In addition, internal validation was good, with bootstrap C-statistic of being 0.736 for asthma and 0.708 for wheeze. Taken together, our findings indicated that the development of asthma and wheeze among preschool-aged children was probably determined by the joint contribution of multiple factors including inherited, nutritional, unhealthy lifestyles, and history of allergic disease. Further validation in other groups is necessary.
Highlights
Asthma is a heterogeneous disease characterized by chronic airway inflammation, and it is defined by the history of respiratory symptoms, such as wheeze, chest tightness, shortness of breath, and cough that are varying over time and in intensity, together with variable expiratory airflow limitation [1]
Via a large-scale cross-sectional survey, data from 9,529 Chinese preschool-aged children were collected to identify and characterize potential factors associated with childhood asthma and wheeze in China
By means of the logistic least absolute shrinkage and selection operator (LASSO) regression, which minimizes multicollinearity between variables, we separately identified seven and eight factors in a significant association with childhood asthma and wheeze
Summary
Asthma is a heterogeneous disease characterized by chronic airway inflammation, and it is defined by the history of respiratory symptoms, such as wheeze, chest tightness, shortness of breath, and cough that are varying over time and in intensity, together with variable expiratory airflow limitation [1]. According to the reports of the International Study of Asthma and Allergies in Childhood (ISAAC), the prevalence of asthma symptoms has exhibited an increasing tendency globally in both children (from 11.1 to 11.6%) and adolescents (13.2– 13.7%). A wide variation existed in the symptom prevalence of childhood asthma worldwide [5]. Compared with some developed countries, such as Austria (11.3%), the United States (8.7%), the United Kingdom (15.4%), and Canada (13%) [6, 7], the prevalence of childhood asthma in China was much lower. The 3rd Nationwide Survey of Childhood Asthma in Urban Areas of China recorded that the prevalence of asthma in children under 14 years had been increased to 3% in 2020 from 2% in 2000
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