title: Decreased importance of environmental risk factors for childhood asthma from 1996 to 2006.
abstract: BACKGROUND
  The large increase in asthma prevalence continues in several, but not all areas. Despite the individual risk factors that have been identified, the reasons for the observed trends in prevalence are largely unknown.
  
  
  OBJECTIVE
  This study sought to characterize what trends in risk factors accompanied trends in asthma prevalence.
  
  
  METHODS
  Two population-based cohorts of 7- to 8-year-old children from the same Swedish study areas examined by expanded International Study of Asthma and Allergy in Childhood questionnaires were compared 10 years apart. In 1996 and 2006, 3430 (97% participation) and 2585 (96% participation) questionnaires were completed, respectively. A subset was skin-prick-tested: in 1996 and 2006, 2148 (88% participation) and 1700 (90% participation) children, respectively. The adjusted population-attributable fraction (aPAF) was calculated using the prevalence and multivariate odds ratio of each risk factor.
  
  
  RESULTS
  The prevalence of current asthma and wheeze was similar in 1996 and 2006. Allergic sensitization, however, increased from 21% to 30%. The prevalence of parental asthma increased from 17% to 24%, while respiratory infections and maternal smoking decreased (60% to 29% and 32% to 16%, respectively). The aPAFs of non-environmental risk factors for current asthma increased in 1996-2006: allergic sensitization from 35% to 41%, parental asthma from 27% to 45% and male sex from 20% to 25%. Conversely, the aPAFs of environmental risk factors decreased: respiratory infections from 36% to 32% and damp home and maternal smoking from 14% and 19%, respectively, to near zero in 2006.
  
  
  CONCLUSIONS
  From 1996 to 2006, the non-environmental risk factors parental asthma, allergic sensitization and male sex had an increasing or constant importance for current asthma in 7- to 8-year-old children. The importance of the environmental exposures damp home, respiratory infections and maternal smoking decreased. This counterbalancing in risk factors may explain the level of prevalence of current asthma.
authors.affiliation: Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Gothenburg, Sweden; Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, the OLIN Unit, Umeå University, Umeå, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Bjerg
authors.forename: L
authors.initials: L
authors.lastname: Hedman
authors.forename: M
authors.initials: M
authors.lastname: Perzanowski
authors.forename: G
authors.initials: G
authors.lastname: Wennergren
authors.forename: B
authors.initials: B
authors.lastname: Lundbäck
authors.forename: E
authors.initials: E
authors.lastname: Rönmark
mesh_terms: D001249:Asthma / Q000453:epidemiology* / Q000209:etiology; D002593:Cetrimonium Compounds; D002648:Child; D004338:Drug Combinations; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D009226:Myristates; D009539:Nicotinic Acids; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012841:Simethicone; D013229:Stearic Acids; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology
chemical_list: D002593:Cetrimonium Compounds; D004338:Drug Combinations; D009226:Myristates; D009539:Nicotinic Acids; D013229:Stearic Acids; C058060:Prevasore; D012841:Simethicone
keywords: asthma; children; epidemiology; population-attributable fraction; risk factors; wheeze