Temporal Changes in the Prevalence of Childhood Asthma and Allergies in Urban and Rural Areas of Cyprus: Results from Two Cross Sectional Studies

Overview

Journal BMC Public Health

Publisher Biomed Central

Specialty Public Health

Date 2011 Nov 15

PMID 22074450

Citations 9

Authors

Ourania Kolokotroni

Nicos Middleton

Nicolas Nicolaou

Spyros Pipis

Kostas N Priftis

Donald K Milton

Panayiotis K Yiallouros

Affiliations

Soon will be listed here.

Abstract

Background: The prevalence of childhood asthma and allergies in Cyprus was significantly higher in urban compared to rural areas back in the year 2000, against a background of an overall low prevalence (e.g. current wheeze 6.9%) by comparison to northern European countries. In this study we aimed to assess temporal changes in the prevalence of asthma and allergies in Cyprus after an 8-year interval and to examine whether any differential changes have occurred in urban and rural parts of the island.

Methods: During the academic years 1999-2000 and 2007-2008, the parents of 7-8 year old children residing in the same set of urban and rural areas completed the ISAAC core questionnaire. In addition to providing prevalence estimates of allergic diseases in 2000 and 2008, changes between the two periods were expressed as odds ratios estimated in multiple logistic regression models adjusting for survey participants' characteristics.

Results: The prevalence of current wheeze was higher in 2008 (8.7%, 95% confidence interval 7.5%-9.9%, n = 2216) than the previously recorded figure in 2000 (6.9%, 95% CI 6.2%-7.6%, OR = 1.25, 95% CI: 1.02-1.53, n = 4944). Significant increases were also seen in the prevalence of lifetime asthma (11.3% vs. 17.4%, OR = 1.59, CI: 1.36-1.86), eczema (6.8% vs. 13.5%, OR = 1.91, CI: 1.59-2.29) and allergic rhinoconjuctivitis (2.6% vs. 5.2%, OR = 1.82, CI: 1.39-2.41). The prevalence of current wheeze nearly doubled between 2000 and 2008 in rural areas (5.4% vs. 9.7%, OR 1.81, CI: 1.24-2.64) while no significant change was observed in urban areas (7.5% vs. 8.4%, OR 1.08, CI: 0.84-1.37); p value for effect modification = 0.04. Rises in asthma and rhinitis prevalence, but not eczema were also more pronounced in rural compared to urban areas.

Conclusions: The prevalence of allergic diseases in Cyprus is still on the rise; recent increases appear more pronounced among children living in rural areas possibly indicating recent environmental and lifestyle changes in these communities.

Citing Articles

Prevalence and Characteristics of Self-Reported Adult Asthma in Cyprus: A Population-Based Observational Study.

Benidis K, Tzortzaki E, Georgiou A, Zachariadou T, Adamidi T, Zannetos S J Asthma Allergy. 2023; 16:215-226.

PMID: 36874225 PMC: 9974514. DOI: 10.2147/JAA.S397784.

12-month prevalence of atopic dermatitis in resource-rich countries: a systematic review and meta-analysis.

Volke A, Toompere K, Laisaar K, Oona M, Tisler A, Johannson A Sci Rep. 2022; 12(1):15125.

PMID: 36068263 PMC: 9448775. DOI: 10.1038/s41598-022-19508-7.

Models for estimating and projecting global, regional and national prevalence and disease burden of asthma: a systematic review.

Romel Bhuia M, Islam M, Nwaru B, Weir C, Sheikh A J Glob Health. 2021; 10(2):020409.

PMID: 33437461 PMC: 7774028. DOI: 10.7189/jogh.10.020409.

The child healthcare system in Cyprus.

Efstathiou E, Theophilou L, Angeli S, Hadjipanayis A Turk Pediatri Ars. 2020; 55(Suppl 1):24-40.

PMID: 32963479 PMC: 7488188. DOI: 10.14744/TurkPediatriArs.2020.17047.

Urbanisation and asthma in low-income and middle-income countries: a systematic review of the urban-rural differences in asthma prevalence.

Rodriguez A, Brickley E, Rodrigues L, Normansell R, Barreto M, Cooper P Thorax. 2019; 74(11):1020-1030.

PMID: 31278168 PMC: 6860411. DOI: 10.1136/thoraxjnl-2018-211793.

References

Savva S, Tornaritis M, Chadjigeorgiou C, Kourides Y, Savva M, Panagi A . Prevalence and socio-demographic associations of undernutrition and obesity among preschool children in Cyprus. Eur J Clin Nutr. 2005; 59(11):1259-65. DOI: 10.1038/sj.ejcn.1602237. View

Gern J . The Urban Environment and Childhood Asthma study. J Allergy Clin Immunol. 2010; 125(3):545-9. PMC: 2860857. DOI: 10.1016/j.jaci.2010.01.037. View

Adler A, Tager I, Quintero D . Decreased prevalence of asthma among farm-reared children compared with those who are rural but not farm-reared. J Allergy Clin Immunol. 2005; 115(1):67-73. DOI: 10.1016/j.jaci.2004.10.008. View

Sole D, Cassol V, Silva A, Teche S, Rizzato T, Bandim L . Prevalence of symptoms of asthma, rhinitis, and atopic eczema among adolescents living in urban and rural areas in different regions of Brazil. Allergol Immunopathol (Madr). 2007; 35(6):248-53. DOI: 10.1157/13112991. View

von Ehrenstein O, von Mutius E, Illi S, Baumann L, Bohm O, von Kries R . Reduced risk of hay fever and asthma among children of farmers. Clin Exp Allergy. 2000; 30(2):187-93. DOI: 10.1046/j.1365-2222.2000.00801.x. View

Kim J, Ellwood P, Asher M . Diet and asthma: looking back, moving forward. Respir Res. 2009; 10:49. PMC: 2703624. DOI: 10.1186/1465-9921-10-49. View

Perkin M, Strachan D . Which aspects of the farming lifestyle explain the inverse association with childhood allergy?. J Allergy Clin Immunol. 2006; 117(6):1374-81. DOI: 10.1016/j.jaci.2006.03.008. View

Pearce N, Ait-Khaled N, Beasley R, Mallol J, Keil U, Mitchell E . Worldwide trends in the prevalence of asthma symptoms: phase III of the International Study of Asthma and Allergies in Childhood (ISAAC). Thorax. 2007; 62(9):758-66. PMC: 2117323. DOI: 10.1136/thx.2006.070169. View

Priftis K, Anthracopoulos M, Nikolaou-Papanagiotou A, Matziou V, Mantziou V, Paliatsos A . Increased sensitization in urban vs. rural environment--rural protection or an urban living effect?. Pediatr Allergy Immunol. 2007; 18(3):209-16. DOI: 10.1111/j.1399-3038.2006.00514.x. View

10.

Riedler J, Eder W, Oberfeld G, Schreuer M . Austrian children living on a farm have less hay fever, asthma and allergic sensitization. Clin Exp Allergy. 2000; 30(2):194-200. DOI: 10.1046/j.1365-2222.2000.00799.x. View

11.

Odhiambo J, Williams H, Clayton T, Robertson C, Asher M . Global variations in prevalence of eczema symptoms in children from ISAAC Phase Three. J Allergy Clin Immunol. 2009; 124(6):1251-8.e23. DOI: 10.1016/j.jaci.2009.10.009. View

12.

Majkowska-Wojciechowska B, Pelka J, Korzon L, Kozlowska A, Kaczala M, Jarzebska M . Prevalence of allergy, patterns of allergic sensitization and allergy risk factors in rural and urban children. Allergy. 2007; 62(9):1044-50. DOI: 10.1111/j.1398-9995.2007.01457.x. View

13.

Ones U, Akcay A, Tamay Z, Guler N, Zencir M . Rising trend of asthma prevalence among Turkish schoolchildren (ISAAC phases I and III). Allergy. 2006; 61(12):1448-53. DOI: 10.1111/j.1398-9995.2006.01145.x. View

14.

Ege M, Frei R, Bieli C, Schram-Bijkerk D, Waser M, Benz M . Not all farming environments protect against the development of asthma and wheeze in children. J Allergy Clin Immunol. 2007; 119(5):1140-7. DOI: 10.1016/j.jaci.2007.01.037. View

15.

Schildcrout J, Sheppard L, Lumley T, Slaughter J, Koenig J, Shapiro G . Ambient air pollution and asthma exacerbations in children: an eight-city analysis. Am J Epidemiol. 2006; 164(6):505-17. DOI: 10.1093/aje/kwj225. View

16.

Nicolaou N, Yiallouros P, Pipis S, Ioannou P, Simpson A, Custovic A . Domestic allergen and endotoxin exposure and allergic sensitization in Cyprus. Pediatr Allergy Immunol. 2006; 17(1):17-21. DOI: 10.1111/j.1399-3038.2005.00352.x. View

17.

Ait-Khaled N, Pearce N, Anderson H, Ellwood P, Montefort S, Shah J . Global map of the prevalence of symptoms of rhinoconjunctivitis in children: The International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three. Allergy. 2009; 64(1):123-48. DOI: 10.1111/j.1398-9995.2008.01884.x. View

18.

Braback L, Hjern A, Rasmussen F . Trends in asthma, allergic rhinitis and eczema among Swedish conscripts from farming and non-farming environments. A nationwide study over three decades. Clin Exp Allergy. 2004; 34(1):38-43. DOI: 10.1111/j.1365-2222.2004.01841.x. View

19.

Noal R, Menezes A, Macedo S, Dumith S . Childhood body mass index and risk of asthma in adolescence: a systematic review. Obes Rev. 2010; 12(2):93-104. DOI: 10.1111/j.1467-789X.2010.00741.x. View

20.

Priftis K, Panagiotakos D, Anthracopoulos M, Papadimitriou A, Nicolaidou P . Aims, methods and preliminary findings of the Physical Activity, Nutrition and Allergies in Children Examined in Athens (PANACEA) epidemiological study. BMC Public Health. 2007; 7:140. PMC: 1934355. DOI: 10.1186/1471-2458-7-140. View