Sex differences in the association between asthma incidence and modifiable risk factors in Korean middle-aged and older adults: NHIS-HEALS 10-year cohort

Abstract

BackgroundThis study investigated the sex-specific incidence of asthma and the effects of modifiable risk factors, particularly obesity, on asthma incidence among middle-aged and older individuals in Korea.MethodsWe used data from the National Health Insurance Service-Health Screening Cohort (NHIS-HEALS), which includes health examinees aged 40–79 years in 2002–2003. In total, 459,529 participants with baseline anthropometric measurements were followed-up for 10 years and the development of asthma was evaluated (2004–2013). For subgroup analysis, 246,019 participants who had body mass index (BMI) and waist circumference (WC) measurements taken in 2008–2009 were included in the analysis of the asthma incidence for 2010–2013. Factors associated with asthma were analysed using Cox proportional hazard models.ResultsThe cohort comprised 4,248,813 (men, 2,358,541; women, 1,890,272) person-years of follow-up for 2004–2013. The asthma incidence was 10.58 and 15.03 per 1000 person-years for men and women, respectively. Asthma incidence increased with age, notably so in men. Obesity based on the baseline BMI was significantly associated with asthma development in both sexes (men, HR = 1.23, 95% confidence interval (CI) = 1.13–1.34; women, HR = 1.40 95% CI = 1.32–1.48). High WC was also related to asthma incidence in both sexes with statistical significance (men, HR = 1.34, 95% CI = 1.16–1.57; women, HR = 1.19 95% CI = 1.03–1.37). Analysis of the combined effects of BMI and WC showed that men had a higher asthma risk in the group with both general obesity and abdominal obesity than in the group with non-abdominal obesity and normal BMI. However, obese women had a higher risk of asthma regardless of abdominal obesity. Similarly, smoking was associated with asthma in both sexes but drinking and physical activity showed different associations between the sexes.ConclusionsOur results revealed that asthma incidence was substantially high at old age and lifestyle factors were associated with asthma development. Practical strategies including weight control and healthy lifestyle modification are required to prevent asthma in older people.

Relationship between Body Mass Index and Gender with Asthma

“…The largest percentage of individuals with asthma was noticed in the non-smoking group. This is in accordance with previous research, which suggests that a greater number of asthma attacks occur when individuals smoke (Park, Jung, & Kwon, 2019). This occurs because smoking can cause inflammation of the respiratory tract (Nusa & Widyastiti, 2016).…”

“…This is not in line with previous studies, which suggest that there is a relationship between being overweight and having asthma (de Castro Mendes et al, 2019). Other research studies have revealed a relationship between being overweight and experiencing asthma only in males (Park, Jung, & Kwon, 2019). The statistical test results revealed no relationship between obesity and asthma in Indonesia.…”

Different effects of smoking on atopic and non‐atopic adult‐onset asthma

“… 5 Several other studies have confirmed these findings. 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 Moreover, we observed in the FEAS that the risk of adult‐onset asthma related to current or past smoking was about 2.4 times higher in women compared to never smoking men. 5 Thus, our previous results suggested that women are more susceptible to the harmful effects of smoking.…”

Weight gain from early to middle adulthood increases the risk of incident asthma later in life in the United States: a retrospective cohort study

“…However, many previous cohort studies [ 7 – 10 ] included only a single measurement of Body Mass Index (BMI), which ignored the dynamic feature of body weight over time. Thus, more studies are needed to assess the long-term consequences of weight change during certain life periods.…”