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Vol. 46. Issue 4.
Pages 341-353 (July - August 2018)
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Vol. 46. Issue 4.
Pages 341-353 (July - August 2018)
Original Article
DOI: 10.1016/j.aller.2018.01.002
An international comparison of risk factors between two regions with distinct differences in asthma prevalence
K. Madania, E. Vlaskib, D.C. Renniec,d, M. Searse, J.A. Lawsond,f,
Corresponding author

Corresponding author.
a Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
b Department of Pulmonology and Allergology, University Children's Clinic, Skopje, Macedonia
c College of Nursing, University of Saskatchewan, Saskatoon, Canada
d Canadian Center for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Canada
e Division of Respirology, Department of Medicine, McMaster University, Hamilton, Canada
f Department of Medicine, University of Saskatchewan, Saskatoon, Canada
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Tables (5)
Table 1. Distribution of personal characteristics by location.
Table 2. Distribution of environmental characteristics by location.
Table 3. Distribution of dietary characteristics by location.
Table 4. Results from multiple logistic regression analyses with asthma or current wheeze as the outcome by location of residence.
Table 5. Adjusted associations between location and asthma or current wheeze followed by associations after removal of each factor to explore potential mediation.
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Background and purpose

Investigation of the geographic variation in asthma prevalence can improve our understanding of asthma etiology and management. The purpose of our investigation was to compare the prevalence of asthma and wheeze among adolescents living in two distinct international regions and to investigate reasons for observed differences.


A cross-sectional survey of 13–14 year olds was completed in Saskatoon, Canada (n=1200) and Skopje, Republic of Macedonia (n=3026), as part of the International Study of Asthma and Allergies in Childhood (ISAAC) Phase 3 study. Surveys were self-completed by students following the ISAAC protocol. Multiple logistic regression models were used to investigate associations with reports of asthma and current wheeze. A mediation analysis was then completed.


Asthma prevalence was much higher in Saskatoon than Skopje (21.3% vs. 1.7%) as was the prevalence of current wheeze (28.2% vs. 8.8%). Higher paracetamol (acetaminophen) use was a consistent risk factor for asthma and wheeze in both locations and showed dose-response relationships. In both countries, paracetamol use and physical activity mediated some of the association for both asthma and wheeze. In Saskatoon, among those with current wheeze, 42.6% reported ever having a diagnosis of asthma compared to 10.2% among Skopje adolescents.


The results suggest that the variation in risk factors between the two locations may explain some of the differences in the prevalence of asthma and wheeze between these two study sites. However, diagnostic labeling patterns should not be ruled out as another potential explanatory factor.

Geographic variation


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