title: Lifestyle domains as determinants of wheeze prevalence in urban and rural schoolchildren in Ecuador: cross sectional analysis.
abstract: BACKGROUND
  The acquisition of a modern lifestyle may explain variations in asthma prevalence between urban and rural areas in developing countries. However, the effects of lifestyle on asthma have been investigated as individual factors with little consideration given to the effects of lifestyle as a set of attributes. The aim of the present study was to identify modern lifestyle domains and assess how these domains might explain wheeze prevalence in urban and rural areas.
  
  
  METHODS
  We analysed data from cross-sectional studies of urban and rural schoolchildren in Esmeraldas Province, Ecuador. Variables were grouped as indicators of socioeconomic factors, sedentarism, agricultural activities and household characteristics to represent the main lifestyle features of the study population. We used multiple correspondence analyses to identify common lifestyle domains and cluster analysis to allocate children to each domain. We evaluated associations between domains and recent wheeze by logistic regression.
  
  
  RESULTS
  We identified 2-3 lifestyle domains for each variable group. Although wheeze prevalence was similar in urban (9.4%) and rural (10.3%) schoolchildren, lifestyle domains presented clear associations with wheeze prevalence. Domains relating to home infrastructure (termed transitional, rudimentary, and basic urban) had the strongest overall effect on wheeze prevalence in both urban (rudimentary vs. basic urban, OR = 2.38, 95% CI 1.12-5.05, p = 0.024) and rural areas (transitional vs. basic urban, OR = 2.02, 95% CI 1.1-3.73, p = 0.024; rudimentary vs. basic urban, OR = 1.88, 95% CI 1.02-3.47, p = 0.043). A high level of sedentarism was associated with wheeze in the rural areas only (OR = 1.64, 95% CI 1.23-2.18, p = 0.001).
  
  
  CONCLUSIONS
  We identified lifestyle domains associated with wheeze prevalence, particularly living in substandard housing and a high level of sedentarism. Such factors could be modified through programmes of improved housing and education. The use of lifestyle domains provides an alternative methodology for the evaluation of variations in wheeze prevalence in populations with different levels of development.
authors: Laboratorio de Investigación FEPIS, Quinindé, Esmeraldas Province, Ecuador. alejandro.rodriguez@lshtm.ac.uk.|Centro de Investigación en Enfermedades Infecciosas y Crónicas, Pontificia Universidad Católica del Ecuador, Quito, Ecuador. alejandro.rodriguez@lshtm.ac.uk.|Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK. alejandro.rodriguez@lshtm.ac.uk.
authors: Alejandro
authors: A
authors: Rodriguez
authors: Laboratorio de Investigación FEPIS, Quinindé, Esmeraldas Province, Ecuador.
authors: Maritza G
authors: MG
authors: Vaca
authors: Laboratorio de Investigación FEPIS, Quinindé, Esmeraldas Province, Ecuador.
authors: Martha E
authors: ME
authors: Chico
authors: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors: Laura C
authors: LC
authors: Rodrigues
authors: Instituto de Saude Coletiva, Universidade Federal da Bahia, Salvador, Brazil.
authors: Mauricio L
authors: ML
authors: Barreto
authors: Laboratorio de Investigación FEPIS, Quinindé, Esmeraldas Province, Ecuador.|Centro de Investigación en Enfermedades Infecciosas y Crónicas, Pontificia Universidad Católica del Ecuador, Quito, Ecuador.|Clinical Sciences, St George's University of London, London, UK.
authors: Philip J
authors: PJ
authors: Cooper
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001249:Asthma / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003906:Developing Countries / Q000706:statistics & numerical data*; D004484:Ecuador / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D012135:Respiratory Sounds; D012424:Rural Population / Q000706:statistics & numerical data*; D057185:Sedentary Behavior; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014505:Urban Population / Q000706:statistics & numerical data*
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