Urban-rural differences in asthma prevalence among young adolescents: The role of behavioural and environmental factors.
BACKGROUND
Asthma prevalence has been reported to be lower in rural areas compared to urban areas, although this has been inconsistent. This study aims to identify the influence of urban-rural residence on asthma prevalence in adolescents in the Republic of Macedonia and to investigate characteristics that may explain observed associations.


METHODS
Following International Study of Asthma and Allergies in Childhood protocol, a national sample of Macedonian urban and rural dwelling adolescents (12-16 years) was recruited in 2006. Self-completed questionnaires were used to collect data on wheeze and asthma as well as personal, environmental and dietary characteristics. Following descriptive and multiple logistic regression analyses, a mediation analysis approach was performed to help explain observed associations.


RESULTS
A lower prevalence of current wheeze and ever-diagnosed asthma was observed in rural compared to urban dwelling adolescents (4.9% vs. 7.2% and 1.2% vs. 1.9%, respectively). After adjustment for potential confounders, the associations, although still protective, were not statistically significant (wheeze: OR=0.74, 95%CI=0.46-1.21; asthma: OR=0.97, 95%CI=0.38-2.46). The associations between urban-rural status with current wheeze and asthma were mediated by region of the country (wheeze 9%; asthma 19%) and by diet (>5% change for both wheeze and asthma). Having a dog resulted in a strengthening of the association between urban-rural status and current wheeze by 11.9%.


CONCLUSIONS
The prevalence of asthma and wheeze was lower in rural dwelling Macedonian adolescents and the association was mediated by the region of the country with diet likely to be part of the reason for this mediating effect.
Department of Pulmonology and Allergology, University Children's Clinic, Skopje, Republic of Macedonia. Electronic address: emilija.vlashki@gmail.com.
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Vlaski
Department of Medicine, Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada.
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Lawson
D000293:Adolescent; D001249:Asthma / Q000453:epidemiology* / Q000523:psychology; D002648:Child; D004032:Diet; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D018843:Republic of North Macedonia; D012424:Rural Population; D012919:Social Behavior; D011795:Surveys and Questionnaires; D014505:Urban Population
Adolescents; Asthma; Behavioural factors; Dietary factors; Environmental factors; Regional differences; Rural; Urban; Wheeze