The Urban-Rural Gradient In Asthma: A Population-Based Study in Northern Europe

Signe Timm, Morten Frydenberg, Christer Janson, Brittany Campbell, Bertil Forsberg, Thorarinn Gislason, Mathias Holm, Rain Jogi, Ernst Omenaas, Torben Sigsgaard, Cecilie Svanes and Vivi Schlünssen
Additional contact information
Signe Timm: Department of Public Health, Danish Ramazzini Centre, Aarhus University, DK-8000 Aarhus C, Denmark
Morten Frydenberg: Department of Public Health, Danish Ramazzini Centre, Aarhus University, DK-8000 Aarhus C, Denmark
Christer Janson: Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, 751 05 Uppsala, Sweden
Brittany Campbell: Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria 3010, Australia
Bertil Forsberg: Division of Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden
Thorarinn Gislason: Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik IS-108, Iceland
Mathias Holm: Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg 405 30, Sweden
Rain Jogi: Lung Clinic, Tartu University Hospital, Tartu 50406, Estonia
Ernst Omenaas: Institute of Clinical Science, University of Bergen, 5020 Bergen, Norway
Torben Sigsgaard: Department of Public Health, Danish Ramazzini Centre, Aarhus University, DK-8000 Aarhus C, Denmark
Cecilie Svanes: Institute of Clinical Science, University of Bergen, 5020 Bergen, Norway
Vivi Schlünssen: Department of Public Health, Danish Ramazzini Centre, Aarhus University, DK-8000 Aarhus C, Denmark

IJERPH, 2015, vol. 13, issue 1, 1-14

Abstract: The early life environment appears to have a persistent impact on asthma risk. We hypothesize that environmental factors related to rural life mediate lower asthma prevalence in rural populations, and aimed to investigate an urban-rural gradient, assessed by place of upbringing, for asthma. The population-based Respiratory Health In Northern Europe (RHINE) study includes subjects from Denmark, Norway, Sweden, Iceland and Estonia born 1945–1973. The present analysis encompasses questionnaire data on 11,123 RHINE subjects. Six categories of place of upbringing were defined: farm with livestock, farm without livestock, village in rural area, small town, city suburb and inner city. The association of place of upbringing with asthma onset was analysed with Cox regression adjusted for relevant confounders. Subjects growing up on livestock farms had less asthma (8%) than subjects growing up in inner cities (11%) (hazard ratio 0.72 95% CI 0.57–0.91), and a significant urban-rural gradient was observed across six urbanisation levels ( p = 0.02). An urban-rural gradient was only evident among women, smokers and for late-onset asthma. Analyses on wheeze and place of upbringing revealed similar results. In conclusion, this study suggests a protective effect of livestock farm upbringing on asthma development and an urban-rural gradient in a Northern European population.

Keywords: asthma; early life environment; farming; microbial exposure; urban-rural gradient; hygiene hypothesis; RHINE (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2015
References: View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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