Koncor1_2014.PM6


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ASSOCIATION OF FAMILIAL AND ENVIRONMENTAL FACTORS
WITH ASTHMA AND ALLERGIC DISEASES IN UKRAINIAN
CHILDREN POPULATION

O. Ye. Fedortsiv1, J. E. Zejda2, N. Yu. Luchyshyn1, G. M. Brozek2
1 I. YA. HORBACHEVSKY TERNOPIL STATE MEDICAL UNIVERSITY, TERNOPIL, UKRAINE

2 MEDICAL UNIVERSITY OF SILESIA, KATOWICE, POLAND

Background. Asthma and other allergic diseases as influenced by environmental and familial factors might
be targeted using preventive measures. These diseases are a matter of some urgency in Ukraine because of
the clinical, social and economic importance in childhood.

Objective. The aim of this study was to investigate the relationship between prevalence of asthma, spastic
bronchitis, allergic rhinitis, atopic eczema, unspecified hypersensitization and some selected environmental
and familial factors in a population sample of 6 to14-yrs old Western Ukraine schoolchildren.

Methods. The data set of the study was collected using a questionnaire-based survey, containing the data
of 4871 urban and rural children age 6 to 14 years. Correlation of asthma and allergic disease with familial and
environmental factors was examined by means of multivariate logistic regression.

Results. Increased risk of asthma (1.7 %) was associated with the urban residence (OR=1.8; p=0.04) and
high parental education (OR=1.8; p=0.02); spastic bronchitis (6.2%) – with parental allergy (OR=1.3; p=0.03);
atopic eczema (6.2 %) – with younger age (OR=1.3; p=0.03), high parental education (OR=1.3; p=0.03), parental
allergy (OR=1.4; p=0.02), tobacco smoke at home (OR=0.7; p=0.01) and household density (OR=0.6; p=0.001);
diagnosis of unspecified allergic sensitization (11.8 %) was related to high parental education (OR=1.2; p=0.03),
parental employment (OR=0.8; p=0.02) and pets at home (OR=1.2; p=0.06).

Conclusions. This study identifies that lifeslyle and building factors are associated with an altered prevalence
of common childhood allergic diseases. Prevention may need to address the minimization of potential risk-
factors.

KEY WORDS: asthma, environmental factors, children.

Introduction
Prevalence of asthma and allergies among

children has become an increasing problem during
the last few decades. Asthma has become the most
common chronic disease among children and is one
of the major causes of hospitalization among those
younger than 15 years of age. As more people
become sensitized to allergens, allergic diseases
may increase in Europe in the coming years [1].
Previous ISAAC studies revealed a relatively low
prevalence of allergic diseases specifically in Eastern
Europe. While the results of the studies from different
areas in Eastern Europe have been reported, less
is known about the current epidemiology of childhood
allergic diseases in different areas of Ukraine [2, 3].
With the prevalence of childhood asthma and allergic
diseases increasing worldwide over the past
decades, it is widely accepted that environmental
factors, in addition to genetics, are closely related to
allergic diseases [4, 5]. The role of environmental
factors in relation to asthma and allergy increased

through the 1990s. There has been widespread
public concern that changing patterns of outdoor air
pollution underlie the rising burden of asthma, but
the professionals are not so sure about such
correlations. The indoor environment, in which
people spend most of their time, has received less
attention [6, 7].

The aims of this study was firstly, to quantify the
prevalence of asthma, spastic bronchitis, allergic
rhinitis, atopic eczema, unspecified hypersen-
sitization in schoolchildren in Ternopil and Ternopil
region, and secondly, to evaluate associations
between children's asthma and allergic diseases
from one side and housing and familial charac-
teristics from another.

Methods
We used questionnaire which was based on

the ISAAC symptom questionnaire in Ukrainian
language. The questionnaires were answered by
parents or guardians of children, aged 6 to 14 years
old from Ternopil and surrounding rural area. Issues
and factors affecting the prevalence of physician-
diagnosed asthma, spastic bronchitis, allergic rhinitis,
atopic eczema, and unspecified hypersensitization

Address for correspondence: N. Yu. Luchyshyn, Medical
Department of Paediatrics � 2, I. Ya. Horbachevsky Ternopil
State Medical University, m. Voli, 1, Ternopil, 46001, Ukraine
Tel.: +380660471120;
E-mail: luna.ternopil@gmail.com

O. Ye. Fedortsiv et al.

International Journal of Medicine and Medical Research
2015, Volume 1, Number 1, p. 12-16
copyright © 2015, TSMU, All Rights Reserved



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IJMMR 2015 Vol. 1 No. 1

were included in the list of allergic diseases. The
study protocol was approved by the local ethics
committee at the Ternopil State Medical University
(� 1 (b) from 07.04.2010). Independent variables
of interest were based on questionnaire self-report.
Subgroups of subjects defined by place of residence
(urban/rural), gender (male/female), age group (<10
years old / >10 years old), parental education (less
than high school/high school or above), parental
employment (both unemployed/otherwise), any
diagnosed parental allergy (at least one parent: yes/
no), tobacco exposure at home – smoking adult at
home (yes/no), housing (multi-storey house/
otherwise), heating of the house (coal or wood stove/
otherwise), household density – defined as the ratio
of persons living in the house to rooms in the house
(�1 person per room/otherwise), dampness in house
defined as moisture stains or signs of mold on the
inner surfaces in the house (yes/no), contact with
pets inside the house (yes/no).

Statistical analysis was performed by using
Statistica 7.1 software. Descriptive analyses were
used to examine the prevalence of each outcome
with the personal and environmental characteristics
of the study population. Statistical significance was
assessed using chi2 test. Multivariable logistic
regression analyses with each outcome were used
to examine the association with the personal and
environmental characteristics and to account for
potential confounding. For these analyses, outcomes
were the diseases or symptoms of interest. The
strength of association was based on the Odds ratio
(OR) and 95 % confidence intervals (CI).

Results
Analysis of 4871 completed questionnaires has

found the following results: study population was
50.8 % females and 49.2 % males. 54.7 % of children
lived in an urban area, 47.3 % – in rural. Groups of

children living in urban and rural areas were similar
(p<0.05) in terms of age (10.4±2.0 years and
10.5±2.0 years, respectively) and gender (51.0 %
and 50.5 %, respectively, were females). Descriptive
characteristics of the study population by urban and
rural status are presented in Table 1.

The prevalence of respiratory and allergic
diseases were: childhood asthma – 1.70 %, spastic
bronchitis – 6.26 %, allergic rhinitis – 5.79 %, atopic
dermatitis – 12.40 %, and current chest wheezing –
11.56 %. Table 2 shows the prevalence of respiratory
and allergic outcomes by characteristics of the study
group.

Bronchial asthma prevailed in children from
urban areas or those with a higher parental
education. A higher prevalence of spastic bronchitis
was found among those with a parental history of
allergy. A higher prevalence of allergic rhinitis was
also found among those in an urban area compared
to a rural area. There were no statistically significant
differences between categories of the characteristics
considered for atopic eczema.

As results from logistic regression analysis, we
found that an increased risk of asthma was
associated with urban residence (p=0.04) and high
parental education (p=0.02). Spastic bronchitis was
associated with parental allergy (p=0.03). Atopic
eczema had statistically significant associations with
younger age (p=0.03), high parental education
(p=0.03), parental allergy (p=0.02), tobacco smoke
at home (p=0.02) and household crowding
(p=0.0007). Diagnosis of unspecified sensitization
was related to high parental education (p=0.03) and
parental employment (p=0.02) (Table 3).

Discussion
This study was designed to assess the

relationship between physician-diagnosed asthma,
spastic bronchitis, allergic rhinitis, atopic eczema,

Table 1. Descriptive characteristics of the study population in the Ternopil region.

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Table 2. Frequencies of questionnaire-based variables during the examinatoin of population

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unspecified hypersensitization and various family risk
and environmental factors while using representative
sample of schoolchildren in the 6 to 14 yrs-old age
group from a defined geographical area. It was found
that 1.7 % had physician diagnosed asthma,
6.26 % – spastic bronchitis, 5.79 % – allergic rhinitis
and 12.40 % – atopic dermatitis. The prevalence of
childhood asthma in the Ternopil Region was
relatively low comparing to other studies from
Eastern Europe and much lower than in the recent
findings in children of Kiev (8.1 % in 6–7 years old
children and 6.1 % in the 13–14 year old children)
[Akopian A. Z. – unpublished report].

There is an evidence to support an underdiag-
nosis of asthma in this study population. Low
prevalence of childhood asthma in the Ternopil

Region and frequent occurrence of allergic diseases
at the same time, within the range of the published
data, suggests an asthma underdiagnosis. Our study
revealed a relatively frequent occurrence of spastic
bronchitis (6.2 %), which is suggestive of an asthma-
like response. However, it is lower then the previous
report for central and eastern European children [8].

Using multivariable logistic regression analysis,
it was established that urban residence was positively
associated with asthma, while parental allergy - with
spastic bronchitis in children. High parental education
was related to asthma, atopic eczema and unspe-
cified sensitization of children. Parental allergy,
tobacco smoke at home, household crowding were
positively associated with children’s atopic eczema.
Keeping pets at home was related with unspecified
sensitization of children.

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Conclusions
This cross-sectional examination suggests that

environmental and family risk factors are associated
with prevalence of asthma, spastic bronchitis, atopic
eczema and unspecified sensitization in 6 to 14-yrs-
old schoolchildren in Ternopil. The determination of
potentially preventable environmental and family
factors affecting risk of allergic disease is important,
considering the apparent world-wide increases in the
prevalence of childhood allergic disease. This study
identifies lifestyle, building factors which are
associated with an altered prevalence of common

childhood allergic disease. Prevention may need to
address the minimization of potential risk-factors.

Acknowledgments
The authors would like to thank those individuals

who participated in this data collection. The Ministry
of Foreign Affairs (Poland) – Polish Aid 2011: “Polish
Assistance to the Prevention of Large Public Impact
Lung Diseases in Belarus and Ukraine” provided
financial support for the project under the grant [249/
PR/2011]. The authors thank the children and
parents who participated in this study.

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Table 3. Associations of allergic diseases with environmental and familiar factors
(multivariate logistic regressions)

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Received: 2014.05.26

O. Fedortsiv et al.