The Epidemiological Characteristics And Related Factors Of Allergic Diseases In Preschool Children In Shanghai

Background & ObjectiveThe prevalence of asthma and other allergic diseases has increased significantly around the world.Allergic diseases are mostly caused by the environmental and behavioral factors.As a susceptible group,preschool children have relatively weak immune system compared with adults,and are more likely to suffer from asthma and other allergic diseases under the same level of exposure.Therefore,the purpose of this study is to describe the prevalence of allergic diseases of preschool children in Shanghai in 2019,to explore the relationship between demographic characteristics,perinatal health,and childhood environmental behavior factors and allergies,and to describe the current situation of kindergarten management in Shanghaiso,as to provide scientific basis for the development of prevention strategies for allergic diseases.MethodsThe cross-sectional epidemiological survey was carried out from April 2019 to June 2019 through multi-stage cluster sampling.In this study,417 kindergarten teachers and 6236 preschool children(3-7 years old)from 31 kindergartens in 8 districts of Shanghai were selected.The data were collected by using the children’s allergic disease screening scale,the perinatal health questionnaire and the children’s environmental behaviorial questionnaire.The questionnaire covers the following information: children’s allergic diseases,social demographic data,perinatal health,children’s environmental behavioral health factors.Descriptive statistical method was carried out on the collected data,to describe the sample characteristics and the prevalence of allergic diseases.Binary logistic regression statistical model was used for univariate and multivariate analysis.ResultsIn 2019,the prevalence of four types allergic diseases among 6236 preschool children in Shanghai was 14.6% for asthma,16.2% for wheezing,25.6% for allergic rhinitis and 43.3% for eczema.The prevalence of the four types of allergic diseases was higher in men than in women,and higher in urban areas than in suburban areas.The prevalence of rhinitis increased with age,and that of eczema decreased with age.Multivariate analysis demonstrated that the following factors were associated with all the four types of allergic disease: male gender,family history of allergy,insufficient maternal sleep duration during pregnancy,poor sleep quality of children,lack of exercise of children and mold contamination.In addition,preterm delivery,cesarean section and family gardening are all related to asthma,wheezing and rhinitis.Besides,eczema is related to three pregnancy complications: gestational hypertension(OR=2.166,95% CI: 1.350-3.475),gestational diabetes(OR=1.509,95% CI: 1.058-2.152),and gestational anemia(OR=1.439,95% CI: 1.047-1.976).In the aspect of environment,the relationship between allergic rhinitis and renovation is more significant: renovation before pregnancy(OR=1.392,95% CI: 1.151-1.683),renovation after childbirth(OR=1.520,95% CI: 1.160-1.990),renovation of kindergarten(OR=1.196,95% CI: 1.014-1.409).At the same time,family and kindergarten renovation have combined effect,and can also increase the risk of allergic rhinitis without family history of allergy.After crossover analysis,compared with no family and kindergarten renovation,the odds ratio and 95%coefficient inverval of only family decoration,only kindergarten decoration,and both family and kindergarten renovation were(OR=1.386,95% CI: 1.122-1.711),(OR= 1.290,95% CI: 1.033-1.610)and(OR= 1.581,95% CI: 1.030-2.424),respectively.The management of public kindergartens in Shanghai is better than that of non-public kindergartens.The proportion of “best fit” of public kindergartens in all indicators of kindergarten health care system,food management system,cultural concept construction and disease prevention and control is basically higher than 90%.The main part of non-public kindergartens should be concentrated around 50%,especially in the cultural construction of kindergartens,which is quite different from that in public kindergartens.The kindergarten management level was associated with childhood allergic diseases.The high score of health care work in the kindergarten was the protective factor of rhinitis(OR = 0.788,95% CI: 0.702-0.882)and eczema(OR = 0.820,95% CI: 0.719-0.938),respectively;the high score of health care staffingin the kindergarten was negatively associated with rhinitis(OR = 0.841,95% CI: 0.763-0.932)and eczema(OR = 0.854,95% CI: 0.769-0.935),respectively;and the high score of environmental health security in the kindergarten was related to rhinitis(OR = 0.843,95% CI: 0.797-0.995)and eczema(OR = 0.850,95% CI: 0.789-0.964),respectively.ConclusionThis study suggests that the prevalence of allergic diseases among preschool children in Shanghai is higher than that in previous years,and they are higher in urban area and boys.Parents with high socio-economic status,older pregnant women,premature delivery,cesarean section,family history of allergy,maternal gestational complications and unhealthy pregnancy behavior,children’s unhealthy behavior,poor family and kindergarten environment could increase the risk of allergic diseases.In addition,there may be more perinatal health factors related to eczema than allergic diseases of respiratory system.We should pay more attention to the prevention and control of family environment and kindergarten environment.Generally,the management of kindergartens in Shanghai is quite good.We find that public kindergartens do better than non-public kindergartens in terms of health care system,food management system,cultural concept construction and disease prevention and control.For the managers of the kindergartens,more actions should be taken to improve the level of health care work,the health care stuffing and the environmental health security in kindergartens.