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Asthma in South African adolescents: a time trend and risk factor analysis over two decades

Cynthia B. Baard, Zoe Franckling-Smith, Jacinta Munro, Lesley Workman, Heather J. Zar
ERJ Open Research 2021 7: 00576-2020; DOI: 10.1183/23120541.00576-2020
Cynthia B. Baard
University of Cape Town, Dept of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and the SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
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Zoe Franckling-Smith
University of Cape Town, Dept of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and the SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
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Jacinta Munro
University of Cape Town, Dept of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and the SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
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Lesley Workman
University of Cape Town, Dept of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and the SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
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Heather J. Zar
University of Cape Town, Dept of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and the SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
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Tables

  • TABLE 1

    Participant characteristics

    CategoryTotal n=3979
    Male1731 (43.5)
    Ancestry
     Black African1699 (42.7)
     Caucasian463 (11.6)
     Mixed ancestry1683 (42.3)
     Other134 (3.4)
    School type
     Public3771 (94.8)
     Private208 (5.2)
    Highest level of maternal education
     Primary school298 (7.5)
     Secondary2002 (50.3)
     Tertiary1597 (40.1)
     Not reported82 (2.1)
    Previous tuberculosis treatment279 (7.0)
    Outdoor pollution1334 (33.5)
    Self-reported smoking (current)348 (8.8)
    Maternal smoking982 (24.7)
    Paternal smoking1402 (35.2)
    Wood used for heating or cooking288 (7.2)
    Exposure to pets2711 (68.1)
    Mother or father employed3523 (88.5)
    Home type – informal home417 (10.5)
    Household assets (<7 items)1975 (49.6)
    Body mass index kg·m−2
     Less than 18.51105 (27.8)
     18.5 to 24.992119 (53.2)
     Above 25747 (18.8)
     Not reported8 (0.2)
  • TABLE 2

    Comparison of prevalence of asthma symptoms by written questionnaire among South African adolescents, 2002 (ISAAC III) and 2017 (GAN I)

    2002 (ISAAC III) n (%)2017 (GAN I) n (%)2002 to 2017 OR (95% CI)
    Subjects n50373979
    Wheeze ever1670 (33.1)1373 (34.5)1.06 (0.97–1.16)
    Wheezing last 12 months1025 (20.3)847 (21.3)1.06 (0.96–1.17)
    Four or more attacks of wheezing in last 12 months254 (5.0)230 (5.8)1.15 (0.96–1.39)
    Woken by wheezing one or more nights per week in last 12 months252 (5.0)275 (6.9)1.41 (1.18–1.68)
    Severe wheeze limiting speech to one or two words at a time in last 12 months395 (7.8)468 (11.8)1.57 (1.36–1.80)
    Exercise-induced wheeze in last 12 months1641 (32.6)1431 (36.0)1.16 (1.06–1.27)
    Night cough in last 12 months1846 (36.6)1648 (41.4)1.22 (1.12–1.33)
    Diagnosis of asthma ever725 (14.4)660 (16.6)1.18 (1.05–1.33)
  • TABLE 3

    Comparison of prevalence of asthma symptoms by video questionnaire among South African adolescents, 2002 (ISAAC III) and 2017 (GAN I)

    Timeframe2002 (ISAAC III) n (%)2017 (GAN I) n (%)2002 to 2017 OR (95% CI)
    Wheeze
     Ever840 (16.9)887 (22.5)1.45 (1.30–1.61)
     In the last 12 months559 (11.2)737 (18.7)1.84 (1.63–2.07)
     In the last month351 (7.0)513 (13.0)1.92 (1.66–2.21)
    Exercise-induced wheeze
     Ever1070 (21.3)1480 (37.5)2.23 (2.03–2.44)
     In the last 12 months692 (13.9)1205 (30.6)2.76 (2.49–3.07)
     In the last month466 (9.4)890 (22.6)2.86 (2.53–3.23)
    Nocturnal wheeze
     Ever459 (9.2)517 (13.1)1.50 (1.32–1.72)
     In the last 12 months265 (5.3)376 (9.5)1.90 (1.61–2.23)
     In the last month194 (3.9)275 (7.0)1.87 (1.55–2.26)
    Nocturnal cough
     Ever1501 (30.1)1147 (29.1)0.97 (0.88–1.06)
     In the last 12 months957 (19.2)863 (21.9)1.19 (1.08–1.32)
     In the last month620 (12.5)618 (15.7)1.32 (1.17–1.49)
    Severe wheeze
     Ever603 (12.1)583 (14.8)1.28 (1.13–1.44)
     In the last 12 months347 (7.0)403 (10.2)1.47 (1.27–1.71)
     In the last month216 (4.3)296 (7.5)1.81 (1.51–2.17)
  • TABLE 4

    Univariate and multivariate analysis of exposures and current self-reported asthma on the written questionnaire

    Risk factorCurrent wheeze n=847 (%)No current wheeze n=3132 (%)Univariate analysisMultivariate analysis
    OR (95% CI)p-valueOR (95% CI)p-value
    Sex (male)327 (38.6)1404 (44.8)0.77 (0.66–0.90)0.0010.79 (0.67–0.93)0.006
    Private school69 (8.1)139 (4.4)1.90 (1.40–2.60)<0.0011.66 (1.20–2.30)0.002
    Outdoor pollution303 (35.8)1031 (32.9)1.10 (1.00–1.30)0.115
    Self-reported smoking (current)113 (13.3)235 (7.5)1.90 (1.49–2.41)<0.0011.88 (1.46–2.410<0.001
    Maternal smoking235 (27.7)747 (23.9)1.23 (1.03–1.46)0.0191.07 (0.88–1.29)0.520
    Paternal smoking325 (38.4)1077 (34.4)1.18 (1.01–1.39)0.0361.13 (0.95–1.35)0.168
    Wood used for heating or cooking76 (9.0)212 (6.8)1.36 (1.03–1.79)0.0291.18 (0.88–1.57)0.271
    Exposure to pets633 (74.7)2078 (66.3)1.50 (1.26–1.78)<0.0011.40 (1.16–1.67)<0.001
    Mother or father employed781 (92.2)2742 (87.5)1.57 (1.18–2.08)0.0021.48 (1.10–2.00)0.011
    Home type – informal85 (10.0)332 (10.6)0.94 (0.73–1.21)0.634
    Household assets (<7 items)369 (43.6)1606 (51.3)1.36 (1.17–1.59)<0.0010.86 (0.73–1.01)0.078
    Body mass index above 25 kg·m−2171 (20.2)576 (18.4)1.12 (0.93–1.36)0.240
  • TABLE 5

    Univariate and multivariate analysis of exposures and severe asthma on the written questionnaire

    Risk factorSevere wheeze n=669 (%)No severe wheeze n=3310 (%)Univariate analysisMultivariate analysis
    OR (95% CI)p-valueOR (95% CI)p-value
    Sex (male)287 (42.9)1444 (43.6)0.97 (0.82–1.15)0.730
    Private school29 (4.3)179 (5.4)0.79 (0.53–1.18)0.256
    Outdoor pollution260 (38.9)1074 (32.4)1.33 (1.12–1.59)0.0011.26 (1.06–1.51)0.010
    Self-reported smoking (current)103 (15.4)245 (7.4)2.28 (1.78–2.92)<0.0012.29 (1.78–2.94)<0.001
    Maternal smoking146 (21.8)836 (25.3)0.84 (0.68–1.02)0.079
    Paternal smoking240 (35.9)1162 (35.1)1.01 (0.88–1.53)0.612
    Wood used for heating or cooking49 (7.3)239 (7.2)1.02 (0.74–1.40)0.925
    Exposure to pets483 (72.2)2228 (67.3)1.26 (1.05–1.52)0.0141.32 (1.09–1.61)0.005
    Mother or father employed590 (88.2)2933 (88.6)0.89 (0.68–1.17)0.409
    Home type – informal90 (13.5)327 (9.9)1.42 (1.10–1.82)0.0061.38 (1.05–1.81)0.019
    Household assets (<7 items)363 (54.3)1612 (48.7)1.25 (1.06–1.48)0.0091.18 (0.99–1.42)0.072
    Body mass index above 25 kg·m−2130 (19.4)617 (18.6)1.05 (0.85–1.30)0.638
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Asthma in South African adolescents: a time trend and risk factor analysis over two decades
Cynthia B. Baard, Zoe Franckling-Smith, Jacinta Munro, Lesley Workman, Heather J. Zar
ERJ Open Research Apr 2021, 7 (2) 00576-2020; DOI: 10.1183/23120541.00576-2020

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Asthma in South African adolescents: a time trend and risk factor analysis over two decades
Cynthia B. Baard, Zoe Franckling-Smith, Jacinta Munro, Lesley Workman, Heather J. Zar
ERJ Open Research Apr 2021, 7 (2) 00576-2020; DOI: 10.1183/23120541.00576-2020
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