Rising prevalence of asthma is sex-specific in a US farming population

Abstract

Asthma prevalence is increasing worldwide in most populations, likely due to a combination of heritable factors and environmental changes. Curiously, however, some European farming populations are protected from asthma, which has been attributed to their traditional lifestyles and farming practices. We conducted population-based studies of asthma and atopy in the Hutterites of South Dakota, a communal farming population, to assess temporal trends in asthma and atopy prevalence and describe the risk factors for asthma. We studied 1325 Hutterites (ages 6-91 years) at 2 time points from 1996 to 1997 and from 2006 to 2009 by using asthma questionnaires, pulmonary function and methacholine bronchoprovocation tests, and measures of atopy. The overall prevalence of asthma increased over the 10- to 13-year study period (7.5%-11.1%, P= .049), whereas the overall prevalence of atopy did not change (45.0%-44.8%, P= .95). Surprisingly, the rise in asthma was only among females (5.8%-11.2%, P= .02); the prevalence among males remained largely unchanged (9.4%-10.9%, P= .57). Atopy, which was not associated with asthma risk in 1996 to 1997, was the strongest risk factor for asthma among Hutterites studied in 2006 to 2009 (P=.003). Asthma has increased over a 10- to 13-year period among Hutterite females and atopy has become a significant risk factor for asthma, suggesting a change in environmental exposures that are either sex limited or that elicit a sex-specific response.