Socio-demographic factors related to under-diagnosis of childhood asthma in Upper Silesia, Poland

Introduction The presented study of 4,535 children aged 7–17 years in the Upper Silesian region of Poland yielded 186 cases of previously known asthma, and 44 children with newly diagnosed asthma. The aim of the presented study was to identify non-medical factors that could explain why children with a newly established diagnosis (‘undiagnosed asthma’) had not been diagnosed in the past. Material and Methods The study was performed according to a case-control design. Parents of the children answered questionnaires on socio-economic status and family-related factors. Statistical determinants of undiagnosed asthma were explored using raw (OR) and logistic odds ratios with their 95% confidence intervals (logOR, 95%CI). Results Children with undiagnosed asthma were younger compared to the group with previously known asthma (11.3±2.1 vs. 12.6±2.5 years; p=0.0008). Newly diagnosed cases were more frequent in children who had less parental attention (less than 1 hour/day spent by parent with child – OR=4.36; 95%CI: 1.76–10.81) and who were not registered with specialized health care (OR=2.20; 95%CI: 0.95–5.06). Results of logistic regression analysis suggest that under-diagnosis of asthma is related to age below 12 years – logOR = 3.59 (95%CI: 1.28–10.36), distance to a health centre > 5 km – logOR = 3.45 (95%CI: 1.05–11.36), time spent with child < 1 hour/day – logOR = 6.28 (95%CI: 1.98–19.91). Conclusions Among non-medical determinants of undiagnosed asthma the age of a child plays a major role. Another factors of importance is the large distance between residence and health centre, and low parental attention at home

Environmental determinants of underdiagnosis of childhood asthma

Underdiagnosis of childhood asthma is a well known problem in many countries. In Poland the estimated occurrence of this problem reaches 50% and is similar to fi ndings published in foreign literature. The causes of the problem are not unequivocally recognized and are addressed by few authors. Among potential causes there are circumstances related to organization and practice of pediatric health care, including application of standard diagnostic criteria of asthma, availability of diagnostic tests, nozologic preferences, etc. Another category of circumstances in charge of underdiagnosis of childhood asthma stems from environmental infl uences, including family-related factors. Findings published in foreign literature show that underdiagnosis is more frequent in children of low socio-economic status, in rural setting or in families burdened by stress. Evidence however is far from being complete. There is a lack of Polish data on the subject and it remains unknown to what extent underdiagnosis of childhood asthma in this country is related to the above mentioned factors. Scientific investigation into the problem is necessary for a number of reasons and justifies implementation of subject-oriented epidemiological studies. Identification of factors associated with an increased probability of underdiagnosis of childhood asthma should facilitate planning of proper preventive measures, above all involving screening programs addressed to selected groups of population.Niedodiagnozowanie astmy oskrzelowej u dzieci jest dobrze znanym problemem w wielu krajach. W Polsce oszacowana częstość tego problemu sięga 50% i jest podobna do danych cytowanych w zagranicznej literaturze. Przyczyny tego zjawiska nie są jednoznacznie ustalone i podejmowane przez niewielu autorów. Wśród potencjalnych przyczyn można wymienić okoliczności związane z organizacją i praktyką pediatrycznej ochrony zdrowia, w tym niekompletne rozpowszechnienie kryteriów diagnostycznych astmy, ograniczoną dostępność testów diagnostycznych, preferencje nozologiczne, itp. Drugą grupę okoliczności potencjalnie odpowiedzialnych za niedodiagnozowanie astmy u dzieci stanowią uwarunkowania środowiskowe, zwłaszcza czynniki rodzinne. Opublikowane w czasopismach zagranicznych dane wykazują, że niedodiagnozowanie astmy wieku dziecięcego jest częstsze w rodzinach odznaczających się niskim poziomem społeczno-ekonomicznym, w rodzinach mieszkających na wsi lub dotkniętych obecnością sytuacji stresowych. Informacje nie są kompletne. Brak jest krajowych danych na ten temat i nie wiadomo, w jakim stopniu za niedodiagnozowanie astmy u dzieci odpowiedzialne są wymienione okoliczności. Naukowe rozpoznanie tego problemu jest wskazane z wielu względów i uzasadnia wdrożenie stosownych badań epidemiologicznych. Identyfikacja okoliczności zwiększających prawdopodobieństwo niedodiagnozowania astmy wieku dziecięcego powinna ułatwić racjonalne planowanie działań profilaktycznych, przede wszystkim poprzez adresowane do wybranych grup populacyjnych programy badań przesiewowych tej choroby

Socio-demographic factors related to under-diagnosis of childhood asthma in Upper Silesia, Poland

Introduction The presented study of 4,535 children aged 7–17 years in the Upper Silesian region of Poland yielded 186 cases of previously known asthma, and 44 children with newly diagnosed asthma. The aim of the presented study was to identify non-medical factors that could explain why children with a newly established diagnosis (‘undiagnosed asthma’) had not been diagnosed in the past. Material and Methods The study was performed according to a case-control design. Parents of the children answered questionnaires on socio-economic status and family-related factors. Statistical determinants of undiagnosed asthma were explored using raw (OR) and logistic odds ratios with their 95% confidence intervals (logOR, 95%CI). Results Children with undiagnosed asthma were younger compared to the group with previously known asthma (11.3±2.1 vs. 12.6±2.5 years; p=0.0008). Newly diagnosed cases were more frequent in children who had less parental attention (less than 1 hour/day spent by parent with child – OR=4.36; 95%CI: 1.76–10.81) and who were not registered with specialized health care (OR=2.20; 95%CI: 0.95–5.06). Results of logistic regression analysis suggest that under-diagnosis of asthma is related to age below 12 years – logOR = 3.59 (95%CI: 1.28–10.36), distance to a health centre > 5 km – logOR = 3.45 (95%CI: 1.05–11.36), time spent with child < 1 hour/day – logOR = 6.28 (95%CI: 1.98–19.91). Conclusions Among non-medical determinants of undiagnosed asthma the age of a child plays a major role. Another factors of importance is the large distance between residence and health centre, and low parental attention at home