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Effect of antibiotic use on the incidence of asthma and atopic dermatitis in infants

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Authors

이문규

Advisor
원성호
Major
보건대학원 보건학과(보건학전공)
Issue Date
2017-02
Publisher
서울대학교 대학원
Keywords
AsthmaAtopic dermatitisAntibioticsCox proportional hazard modelKaplan-Meier curve
Description
학위논문 (석사)-- 서울대학교 대학원 : 보건학과(보건학전공), 2017. 2. 원성호.
Abstract
Background: Previous studies have shown that both asthma and atopic dermatitis are caused by allergic marching in the childhood, with their cooccurrence or with some pre-existing relationship. Because of these relationship, the behavior of both diseases and their risk factors have been jointly investigated. Asthma and atopic dermatitis are from the complex interplay various factors such as demographic factors, infectious disease related factors, medicinal use factors, dietary related factors, and atmospheric environmental factors are mixed and acting together. Among the various risk factors, the use of antibiotics has been studied to cause long-term changes in intestinal microorganisms such as decreased actinomycetes, increased bacteria, and decreased enzymes. It has also been studied to increase the incidence of allergic sensitization to allergies such as asthma and atopic dermatitis by inhibiting the proper growth of infantile immune system and inhibiting the development of immune tolerance because it causes an increase in the immature microbial growth. Nevertheless, due to the difficulty in diagnosing asthma and atopic dermatitis of less than 5 years old, there have been few studies about disease status and on the risk factors including antibiotic use.
Objective: The purpose of this study is to investigate the effect of antibiotics use in infants on the risk of asthma and atopic dermatitis with the current status of asthma and atopic dermatitis of newborns between 2011 and 2013 in Korea.
Method: This study used claims data of the Health Insurance Review and Assessment Service of newborns born in 2011, 2012, and 2013 in Korea. The registered analysis number of the data requested by the Health Insurance Review and Assessment Service is M2016082442, which is applied to the remote access system and granted access to data. The data to be used in this study were composed by combining the general information, healthcare information, diagnostic information and prescriptions information based on the patient identification code and the key code. The directed acyclic graph (DAG) was made through literature review, and was used to choose confounding variables. Frequency analyses were performed to examine the characteristics of the data, and the prevalences and incidence rates of asthma and atopic dermatitis were estimated. Incidence was estimated by person-month. Kaplan-Meier survival curves were estimated for subjects with the antibiotic use before the diseases, with the antibiotic use before the disease and the respiratory disease, and with the respiratory disease in the antibiotic use and pyelonephritis. Finally, the cox proportional hazard model was used to estimate the hazard ratio for the use of antibiotics in the development of asthma and atopic dermatitis. This study also estimated the hazard ratio for the development of asthma and atopic dermatitis according to the type of antibiotics proposed by WHO.
Results: The prevalence of asthma was about 60% and its incidence rate was 0.0238 per person-month who were less than one year old in 2011-2013, and the prevalence of atopic dermatitis was about 80% and incidence rate was 0.0845 per person-month. Both diseases were found to have higher prevalence and incidence rates for subjects using antibiotics before the diseases. DAG reveals that respiratory disease is a main confounder between asthma, atopic dermatitis and antibiotics, and the subjects were categorized into four different groups based on the antibiotics use and respiratory diseases. Kaplan-Meier survival curves show that both asthma and atopic dermatitis were associated with the highest risk in the group of antibiotic use and respiratory disease. The log-rank test also showed that there was a substantial difference in the survival functions between groups because the significance probability was less than 0.0001. Finally, the hazard ratio of antibiotic use before asthma in the Cox proportional hazards model was estimated to be 1.556 (95% CI: 1.543 - 1.569) for the development of asthma, and hazard ratio of antibiotic use before atopic was estimated to be 1.369 (95% CI: 1.360 - 1.378) for the occurrence of atopic dermatitis. The hazard ratio of antibiotic use for asthma among subjects with respiratory diseases was estimated to be 1.518 (95% CI: 1.510 - 1.527) and the hazard ratio for atopic dermatitis was estimated to be 1.210 (95% CI: 1.205 - 1.215). Effects of different antibiotics were estimated with the Cox proportional hazards model, and hazard ratios of the beta-lactam antibacterials and penicillins for asthma was 1.682 (95% CI: 1.668-1.695), and those for atopic dermatitis was 1.408 (95% CI: 1.399 – 1.417).
Conclusion: In this study, the use of antibiotics before the onset of asthma and atopic dermatitis was found to be an important risk factor affecting the incidence of asthma and atopic dermatitis. Especially, the effect of beta-lactam antibacterials, penicillins on the incidence of asthma and atopic dermatitis was found to be the largest among antibiotics, and thus we can conclude that careful prescription for those antibiotics may be necessary to minimize the risk of asthma and atopic dermatitis in infants.
Language
English
URI
https://hdl.handle.net/10371/128490
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Graduate School of Public Health (보건대학원)Dept. of Public Health (보건학과)Theses (Master's Degree_보건학과)
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