Asthma and Allergic Disorders in Uganda

A Population-Based Study Across Urban and Rural Settings

Brooks W. Morgan, Trishul Siddharthan, Matthew R. Grigsby, Suzanne Pollard, Robert Kalyesubula, Robert A Wise, Bruce Kirenga, William Checkley

Research output: Contribution to journalArticle

Abstract

Background: Allergic diseases are increasing in sub-Saharan Africa, but few studies have characterized the burden among adults. Objective: We conducted a study to evaluate the prevalence and risk factors of allergic disorders in urban and rural Uganda. Methods: We present a cross-sectional analysis of enrollment data from a population-based cohort study of adults aged ≥35 years in urban and rural Uganda. Sociodemographic and both lifetime and 12-month respiratory symptoms data were collected and spirometry was conducted following standard guidelines. Results: In 1,308 adults (median age 43.8 years and 52.3% female), we found an age-adjusted prevalence of 6.8% for asthma (9.8% urban, 4.3% rural; P < .001), 11.9% for allergic rhinitis (16.4% urban, 7.8% rural; P < .001), and 8.2% for eczema (9.9% urban, 7.8% rural; P = .15). Urbanization was the primary driver of asthma, accounting for 61.4% of cases (95% confidence interval [CI] 22.0% to 83.4%), and was the strongest risk factor for any allergic illness (odds ratio [OR] = 1.87, 95% CI 1.39-2.51). Parental asthma was not associated with allergic illness. Asthma was associated with a lower forced expiratory volume in 1 second (FEV1) by 0.56 z scores (95% CI 0.33-0.80). We found a dose-response association between lower quintiles of the FEV1/forced vital capacity ratio and both hospitalization (OR = 1.77, 95% CI 1.21-2.59) and impairment in daily activities (1.65, 1.20-2.27). Conclusions: Asthma and allergic rhinitis were twice as prevalent in urban settings. Asthma was associated with greater impairment and worse lung function outcomes. We identified a high prevalence of allergic disorders in Uganda, which can be expected to increase due to urbanization and resultant exposures throughout early development.

Original languageEnglish (US)
JournalJournal of Allergy and Clinical Immunology: In Practice
DOIs
StateAccepted/In press - Jan 1 2018

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Uganda
Asthma
Confidence Intervals
Population
Urbanization
Forced Expiratory Volume
Odds Ratio
Africa South of the Sahara
Spirometry
Eczema
Vital Capacity
Hospitalization
Cohort Studies
Cross-Sectional Studies
Guidelines
Lung

Keywords

  • Allergies
  • Asthma
  • Eczema
  • Epidemiology
  • Population attributable fraction
  • Rhinitis
  • Risk factors
  • Sub-Saharan Africa
  • Uganda

ASJC Scopus subject areas

  • Immunology and Allergy

Cite this

Asthma and Allergic Disorders in Uganda : A Population-Based Study Across Urban and Rural Settings. / Morgan, Brooks W.; Siddharthan, Trishul; Grigsby, Matthew R.; Pollard, Suzanne; Kalyesubula, Robert; Wise, Robert A; Kirenga, Bruce; Checkley, William.

In: Journal of Allergy and Clinical Immunology: In Practice, 01.01.2018.

Research output: Contribution to journalArticle

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abstract = "Background: Allergic diseases are increasing in sub-Saharan Africa, but few studies have characterized the burden among adults. Objective: We conducted a study to evaluate the prevalence and risk factors of allergic disorders in urban and rural Uganda. Methods: We present a cross-sectional analysis of enrollment data from a population-based cohort study of adults aged ≥35 years in urban and rural Uganda. Sociodemographic and both lifetime and 12-month respiratory symptoms data were collected and spirometry was conducted following standard guidelines. Results: In 1,308 adults (median age 43.8 years and 52.3{\%} female), we found an age-adjusted prevalence of 6.8{\%} for asthma (9.8{\%} urban, 4.3{\%} rural; P < .001), 11.9{\%} for allergic rhinitis (16.4{\%} urban, 7.8{\%} rural; P < .001), and 8.2{\%} for eczema (9.9{\%} urban, 7.8{\%} rural; P = .15). Urbanization was the primary driver of asthma, accounting for 61.4{\%} of cases (95{\%} confidence interval [CI] 22.0{\%} to 83.4{\%}), and was the strongest risk factor for any allergic illness (odds ratio [OR] = 1.87, 95{\%} CI 1.39-2.51). Parental asthma was not associated with allergic illness. Asthma was associated with a lower forced expiratory volume in 1 second (FEV1) by 0.56 z scores (95{\%} CI 0.33-0.80). We found a dose-response association between lower quintiles of the FEV1/forced vital capacity ratio and both hospitalization (OR = 1.77, 95{\%} CI 1.21-2.59) and impairment in daily activities (1.65, 1.20-2.27). Conclusions: Asthma and allergic rhinitis were twice as prevalent in urban settings. Asthma was associated with greater impairment and worse lung function outcomes. We identified a high prevalence of allergic disorders in Uganda, which can be expected to increase due to urbanization and resultant exposures throughout early development.",
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AU - Kalyesubula, Robert

AU - Wise, Robert A

AU - Kirenga, Bruce

AU - Checkley, William

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N2 - Background: Allergic diseases are increasing in sub-Saharan Africa, but few studies have characterized the burden among adults. Objective: We conducted a study to evaluate the prevalence and risk factors of allergic disorders in urban and rural Uganda. Methods: We present a cross-sectional analysis of enrollment data from a population-based cohort study of adults aged ≥35 years in urban and rural Uganda. Sociodemographic and both lifetime and 12-month respiratory symptoms data were collected and spirometry was conducted following standard guidelines. Results: In 1,308 adults (median age 43.8 years and 52.3% female), we found an age-adjusted prevalence of 6.8% for asthma (9.8% urban, 4.3% rural; P < .001), 11.9% for allergic rhinitis (16.4% urban, 7.8% rural; P < .001), and 8.2% for eczema (9.9% urban, 7.8% rural; P = .15). Urbanization was the primary driver of asthma, accounting for 61.4% of cases (95% confidence interval [CI] 22.0% to 83.4%), and was the strongest risk factor for any allergic illness (odds ratio [OR] = 1.87, 95% CI 1.39-2.51). Parental asthma was not associated with allergic illness. Asthma was associated with a lower forced expiratory volume in 1 second (FEV1) by 0.56 z scores (95% CI 0.33-0.80). We found a dose-response association between lower quintiles of the FEV1/forced vital capacity ratio and both hospitalization (OR = 1.77, 95% CI 1.21-2.59) and impairment in daily activities (1.65, 1.20-2.27). Conclusions: Asthma and allergic rhinitis were twice as prevalent in urban settings. Asthma was associated with greater impairment and worse lung function outcomes. We identified a high prevalence of allergic disorders in Uganda, which can be expected to increase due to urbanization and resultant exposures throughout early development.

AB - Background: Allergic diseases are increasing in sub-Saharan Africa, but few studies have characterized the burden among adults. Objective: We conducted a study to evaluate the prevalence and risk factors of allergic disorders in urban and rural Uganda. Methods: We present a cross-sectional analysis of enrollment data from a population-based cohort study of adults aged ≥35 years in urban and rural Uganda. Sociodemographic and both lifetime and 12-month respiratory symptoms data were collected and spirometry was conducted following standard guidelines. Results: In 1,308 adults (median age 43.8 years and 52.3% female), we found an age-adjusted prevalence of 6.8% for asthma (9.8% urban, 4.3% rural; P < .001), 11.9% for allergic rhinitis (16.4% urban, 7.8% rural; P < .001), and 8.2% for eczema (9.9% urban, 7.8% rural; P = .15). Urbanization was the primary driver of asthma, accounting for 61.4% of cases (95% confidence interval [CI] 22.0% to 83.4%), and was the strongest risk factor for any allergic illness (odds ratio [OR] = 1.87, 95% CI 1.39-2.51). Parental asthma was not associated with allergic illness. Asthma was associated with a lower forced expiratory volume in 1 second (FEV1) by 0.56 z scores (95% CI 0.33-0.80). We found a dose-response association between lower quintiles of the FEV1/forced vital capacity ratio and both hospitalization (OR = 1.77, 95% CI 1.21-2.59) and impairment in daily activities (1.65, 1.20-2.27). Conclusions: Asthma and allergic rhinitis were twice as prevalent in urban settings. Asthma was associated with greater impairment and worse lung function outcomes. We identified a high prevalence of allergic disorders in Uganda, which can be expected to increase due to urbanization and resultant exposures throughout early development.

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