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Epidemiology of Asthma

Epidemiology of Asthma. Xiang Wang, Robert Sljivic , Alan Wong, Kexin Li . PHM142 Fall 2013 Coordinator: Dr. Jeffrey Henderson Instructor: Dr. David Hampson. Basic Epidemiology. Study of the distribution and determinants of human morbidity and mortality. ( Merril 2010)

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Epidemiology of Asthma

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  1. Epidemiology of Asthma Xiang Wang, Robert Sljivic, Alan Wong, Kexin Li PHM142 Fall 2013 Coordinator: Dr. Jeffrey Henderson Instructor: Dr. David Hampson

  2. Basic Epidemiology • Study of the distribution and determinants of human morbidity and mortality. (Merril 2010) • Study of who gets sick and why they get sick. • Distribution in epidemiological terms is usually measured based on two simple concepts: • Prevalence – Prevalence refers to the amount of individuals in the population with a confirmed diagnosis of the disease. • Incidence – Incidence refers to the number of newly diagnosed individual with the condition during a given time period. • Determinants are described in terms of risk factors and possibly effect modifiers.

  3. Distribution of Asthma - Prevalence • Prevalence – Prevalence refers to the amount of individuals in the population with a confirmed diagnosis of the disease. • Canadian Context • Baseline Levels • Trends • Strata of Populations

  4. Canadian Asthma Prevalence 2007-2012, by Gender and Age Prevalence Per 100,000 Year 2007 2011 2012 2008 2009 2010

  5. Canadian Asthma Prevalence 2012 by Gender and Province Prevalence Per 100,000 Male Female Province

  6. Distribution of Asthma- Incidence • Incidence – Incidence refers to the number of newly diagnosed individual with the condition during a given time period. • Uses. • Baseline Levels • Trends • Meaning?

  7. Incidence of Asthma in Ontario

  8. Incidence of Asthma in Canada

  9. Incidence of Asthma in Canada

  10. Determinants • What “causes” asthma • Risk Factors Effect Modifiers • Measures of Association • Relative Risk • Odds Ratio • Confidence Level • Epidemiological Framework- The Casual Pathway

  11. Genetics • Recent studies have identified 19 particular regions within 100 genes of interest • Examples: DPP10,GRPA,SPINK5 • These genes are associated with response to environmental threats such as allergens in the respiratory tract.

  12. Genetics - Interleukins • Over-expression • Plays a role in the initiation of the inflammatory response • IL-13 regulates mucus level and hyperresponsiveness • IL-13 C1112T: 1.389 (1.103-1.749) • IL-4 regulates immunoglobulin E levels • IL-4 C589T: 1.26 (1.12-1.42)

  13. Regular Smoking • Smokers: 1.33 (1.00-1.77) • Ex Smokers: 1.49 (1.12-1.97) • Risk increases as number of cigarettes increases per day

  14. Second Hand Smoke • Environmental Tobacco Smoke (ETS) • Finland study evaluated effect of ETS on health in workplace settings and at home. • Workplace: OR 2.16 (1.26-3.72) • Home: OR 4.77 (1.29-17.7)

  15. Second Hand Smoke • In children, second hand smoke has a greater impact on asthma development. • Compared the number of smokers at home • 1 smoker: 1.21 (1.07-1.37) • 2 smokers: 1.54 (1.31-1.81) • >3 smokers: 1.52 (1.04-2.23)

  16. Environmental Risk Factors • Systematic Review/Meta Analysis (Anderson et al 2013) • Outdoor Air Pollutants (NO2, PM2.5, PM10, Formaldehydes) • Aggregate Risk Ratio • NO2 - 1.07 95% CI (1.02-1.13) • PM2.5 & PM10 - 1.16 95%CI (0.98-1.37) • Formaldehydes - 1.17 95%CI (1.01 – 1.36) • Indoor Air Pollutants • Water Damage -1.12 95%CI(0.98–1.27) • Mold Odour - 1.56 95%CI (1.25–1.95) • Visible Mold - 1.27 95%CI (1.14–1.41) • Dampness - 1.33 95%CI (1.12–1.56)

  17. Casual Pathway Genetic Predisposition Co-morbidities Exposure to Risk Factors Environmental Life style/Habits Various Air Pollutants (PM2.5, PM10, Residential Damping, aeroallergens) Pathophysiology Process Occurs/First set on symptoms Symptoms persist/ Asthma is Diagnosed

  18. Summary Slide • Prevalence of Asthma: National( 2012 is 8.1%.: 6.8% for males and 9.4% for females) -Rates are stable within age strata of the population over the past 5 years. -Provincially, Saskatchewan Females and Yukon Males have the highest. • Incidence of Asthma: national data did not exhibit much change. -Provincially in Ontario, 14% increase from 1996-2000. Mainly due to 30% increase in children 14 and under. • Risk Factors for developing asthma -Genetics (Ex. Interleukin Over-expression) -Second Hand Smoke -Outdoor Pollutants (NO2, CO, PM) -Indoor Pollutants (Mold and Dampness)

  19. References • Yang, H., Dong, H., Dai, Y. & Zheng Y. (2011) Association of interleukin-13 C-1112T and G+2044A polymorphisms with asthma: a meta-analysis. Respirology. 16(7) ,1127-1135. • Anderson HR, Favarato G, Atkinson RW. Long-term exposure to outdoor air pollution and the prevalence of asthma: metaanalysis of multi-community prevalence studies. Air Qual. Atmos. Health 2011 • 2. Pilpari, R., Jaakkola, J.J., Jaakkola, N. & Jaakkola M.S. (2004). Smoking and asthma in adults. European Respirology, 24 (5), 734-739. • 3. Pilpari, R., Jaakkola, J.J., Jaakkola, N. & Jaakkola M.S. (2003). Environmental tobacco smoke and adult-onset asthma: a population-based incident case-control study. American Public Health. 93 (12), 2055-2060.  • 4. Wills-Karp, M. & Finkelman, F.D. (2008). Untangling the complex web of IL-4- and IL-13-mediated signaling pathways. Science Signaling, 1 (51), 1-4. • 5. Lewis, C.A., Antoniak, M., Venn, A.J., Davies, L., Goodwin, A., Salfield, N., Britton, J. & Fogarty, A.W. (2005). Secondhandsmoke, dietary fruit intake, road traffic exposures, and the prevalence of asthma: a cross-sectional study in young children. American Journal Epidemiology, 161 (5), 406-411. • 6. Nie, W., Zhu, Z., Pan, X. & Xiu, Q. (2013). The interleukin-4 -589C/T polymorphism and the risk of asthma: a meta-analysis including 7,345 cases and 7,819 controls. Gene, 520 (1), 22-29. • 7. Gershon, A. S., Guan, J., Wang, C., & To, T. (2010). Trends in asthma prevalence and incidence in Ontario, Canada, 1996-2005: A population study. American Journal of Epidemiology, 172(6), 728-736. • 8. Statistics Canada. Table 105-0501 - Health indicator profile, annual estimates, by age group and sex, Canada, provinces, territories, health regions (2012 boundaries) and peer groups, occasional

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