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      A Systematic Review on the Development of Asthma and Allergic Diseases in Relation to International Immigration: The Leading Role of the Environment Confirmed

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          Abstract

          Background

          The prevalence of asthma and allergic diseases is rising worldwide. Evidence on potential causal pathways of asthma and allergies is growing, but findings have been contradictory, particularly on the interplay between allergic diseases and understudied social determinants of health like migration status. This review aimed at providing evidence for the association between migration status and asthma and allergies, and to explore the mechanisms between migration status and the development of asthma and allergies.

          Methods and Findings

          Systematic review on asthma and allergies and immigration status in accordance with the guidelines set by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The pooled odds ratio (OR) of the prevalence of asthma in immigrants compared to the host population was 0.60 (95% CI 0.45–0.84), and the pooled OR for allergies was 1.01 (95% CI 0.62–1.69). The pooled OR for the prevalence of asthma in first generation versus second generation immigrants was 0.37 (95% CI 0.25–0.58). Comparisons between populations in their countries of origin and those that emigrated vary depending on their level of development; more developed countries show higher rates of asthma and allergies.

          Conclusions

          Our findings suggest a strong influence of the environment on the development of asthma and allergic diseases throughout the life course. The prevalence of asthma is generally higher in second generation than first generation immigrants. With length of residence in the host country the prevalence of asthma and allergic diseases increases steadily. These findings are consistent across study populations, host countries, and children as well as adults. Differences have been found to be significant when tested in a linear model, as well as when comparing between early and later age of migration, and between shorter and longer time of residence.

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          Most cited references48

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          The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.

          Much biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study's generalisability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Initiative developed recommendations on what should be included in an accurate and complete report of an observational study. We defined the scope of the recommendations to cover three main study designs: cohort, case-control and cross-sectional studies. We convened a 2-day workshop in September 2004, with methodologists, researchers, and journal editors to draft a checklist of items. This list was subsequently revised during several meetings of the coordinating group and in e-mail discussions with the larger group of STROBE contributors, taking into account empirical evidence and methodological considerations. The workshop and the subsequent iterative process of consultation and revision resulted in a checklist of 22 items (the STROBE Statement) that relate to the title, abstract, introduction, methods, results, and discussion sections of articles. 18 items are common to all three study designs and four are specific for cohort, case-control, or cross-sectional studies. A detailed Explanation and Elaboration document is published separately and is freely available on the websites of PLoS Medicine, Annals of Internal Medicine and Epidemiology. We hope that the STROBE Statement will contribute to improving the quality of reporting of observational studies.
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            Paradox lost: explaining the Hispanic adult mortality advantage.

            We tested three competing hypotheses regarding the adult "Hispanic mortality paradox": data artifact, migration, and cultural or social buffering effects. On the basis of a series of parametric hazard models estimated on nine years of mortality follow-up data, our results suggest that the "Hispanic" mortality advantage is a feature found only among foreign-born Mexicans and foreign-born Hispanics other than Cubans or Puerto Ricans. Our analysis suggests that the foreign-born Mexican advantage can be attributed to return migration, or the "salmon-bias" effect. However, we were unable to account for the mortality advantage observed among other foreign-born Hispanics.
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              Air pollution and development of asthma, allergy and infections in a birth cohort.

              Few studies have addressed associations between traffic-related air pollution and respiratory disease in young children. The present authors assessed the development of asthmatic/allergic symptoms and respiratory infections during the first 4 yrs of life in a birth cohort study (n = approximately 4,000). Outdoor concentrations of traffic-related air pollutants (nitrogen dioxide PM(2.5), particles with a 50% cut-off aerodynamic diameter of 2.5 mum and soot) were assigned to birthplace home addresses with a land-use regression model. They were linked by logistic regression to questionnaire data on doctor-diagnosed asthma, bronchitis, influenza and eczema and to self-reported wheeze, dry night-time cough, ear/nose/throat infections and skin rash. Total and specific immunoglobulin (Ig)E to common allergens were measured in a subgroup (n = 713). Adjusted odds ratios (95% confidence intervals) per interquartile pollution range were elevated for wheeze (1.2 (1.0-1.4) for soot), doctor-diagnosed asthma (1.3 (1.0-1.7)), ear/nose/throat infections (1.2 (1.0-1.3)) and flu/serious colds (1.2 (1.0-1.4)). No consistent associations were observed for other end-points. Positive associations between air pollution and specific sensitisation to common food allergens (1.6 (1.2-2.2) for soot), but not total IgE, were found in the subgroup with IgE measurements. Traffic-related pollution was associated with respiratory infections and some measures of asthma and allergy during the first 4 yrs of life.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2014
                20 August 2014
                : 9
                : 8
                : e105347
                Affiliations
                [1 ]Universidad del Desarrollo- Clínica Alemana, CAS-UDD, Lo Barnechea Santiago, Chile
                [2 ]Bradford Institute for Health Research, BIHR, Bradford Royal Infirmary, Bradford, United Kingdom
                [3 ]Department of Health Sciences University of York, Heslington, York, United Kingdom
                [4 ]Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
                [5 ]IMIM (Hospital del Mar Research Institute), Barcelona, Spain
                [6 ]CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
                [7 ]Universitat Pompeu Fabra, Departament de Ciències Experimentals i de la Salut, Barcelona, Spain
                University of Vienna, Austria
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: BC EU MP JA JW. Analyzed the data: BC EU MP. Wrote the manuscript: BC EU MP JW JA.

                Article
                PONE-D-14-18057
                10.1371/journal.pone.0105347
                4139367
                25141011
                aa4973e3-4e62-4a70-9292-293da906f08f
                Copyright @ 2014

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 29 April 2014
                : 21 July 2014
                Page count
                Pages: 16
                Funding
                This review was funded by the MeDALL project and the NIHR Collaboration for Applied Health Research and Care (CLAHRC) for Yorkshire and Humberside. MeDALL is a collaborative project funded by the Health Cooperation Work Programme of the 7th Framework programme (grant agreement No. 261357). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Earth Sciences
                Geography
                Human Geography
                Medicine and Health Sciences
                Epidemiology
                Public and Occupational Health
                People and Places
                Population Groupings
                Social Sciences
                Custom metadata
                The authors confirm that all data underlying the findings are fully available without restriction. http://www.crd.york.ac.uk/PROSPERO/, registration No. CRD42014008883.

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