O R I G I NA L A R T I C L E
Geographical and Sociodemographic
Risk Factors for Allergic Diseases in
Korean Children
Hyejung Lee, PhD, RNC, APRN, Gwang Suk Kim*, PhD, RN
Assistant Professor, College of Nursing, Yonsei University, Seoul, Korea
Purpose (a) To examine geographical distribution of childhood allergic diseases in Korea and (b) to
identify geographical and sociodemographic risk factors for allergic diseases.
Methods Data on doctor-diagnosed asthma during lifetime and allergic rhinitis and atopic dermatitis
during the past 12 months of 8,631 children (≤ 18 years) were obtained from the Third Korea National
Health and Nutrition Examination Survey, along with information on housing type and presence of an
indoor smoker. The SaTScan program identified geographical case clusters of allergic diseases, and multiple logistic regression determined risk factors, including geographical case clusters, for each allergic disease.
Results Prevalence of asthma, allergic rhinitis, and atopic dermatitis was 3.2%, 13.2%, and 15.5%,
respectively. Older children (10–18 years) were more likely to have allergic rhinitis whereas younger children
were more likely to have atopic dermatitis. It is noteworthy that children living in areas of geographical risk
for asthma and atopic dermatitis were more likely to develop the respective allergic disease than children
living in other areas (odds ratio [OR] = 3.47 for asthma, and OR = 9.74 for atopic dermatitis).
Conclusions This study indicates that the areas in which children live may influence the development
of certain allergic diseases. Implications include the need to assess geographical location of children with
allergic diseases and to develop community-based preventive programs for children with allergic diseases.
[Asian Nursing Research 2011;5(1):1–10]
Key Words
allergic rhinitis, asthma, atopic dermatitis, geographic factor, Korea
INTRODUCTION
During the past 2 decades, the increasing prevalence of allergic diseases such as asthma, allergic rhinitis, and atopic dermatitis has become a significant
public health issue in Asia as well as in Westernized
countries (Barnetson & Rogers, 2002; Lee & Hwang,
2008; Zar, Ehrlich, Workman, & Weinberg, 2007).
In Korea, the current prevalence in children and adolescents ranges from 8% to 10% for asthma, 10% to
30% for allergic rhinitis, and 16% to 29% for atopic
dermatitis, which reports a rapid increase compared
to the past decade (Korean National Health Insurance
Corporation, 2008).
Allergic diseases are well known to be highly
heredity (Larsson et al., 2008). When parents have
an allergic disease, children are more likely to develop
the same allergic disease as well as concomitant allergic diseases (Sarafino, 2000; Sebok, Schneider, &
Harangi, 2006). However, the fact that some children
*Correspondence to: Gwang Suk Kim, PhD, RN, College of Nursing, Yonsei University, 134 Shinchondong, Seodaemun-gu, Seoul, Korea 120-752.
E-mail: gskim@yuhs.ac
Received: July 6, 2010
Asian Nursing Research ❖ March 2011 ❖ Vol 5 ❖ No 1
Revised: September 27, 2010
Accepted: December 10, 2010
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H.J. Lee, G.S. Kim
develop allergic diseases even though their parents
do not have any, and that the prevalence of allergic
diseases varies by country and regions within a
country suggest that environmental factors may also
play an important role in the development of childhood allergic diseases (Asher & Dagli, 2004; Kurt
et al., 2007; Tomac, Demirel, Acun, & Ayoglu, 2005;
Williams et al., 1999). Children living in urban areas
and developed countries are more likely to experience asthma and other allergic diseases than children
living in rural areas and developing countries (Asher
et al., 2006; Dorner, Lawrence, Rieder, & Kunze,
2007; Majeed, Rajar, Shaikh, Majeed, & Arain, 2008;
Priftis et al., 2007). These results may be attributed
to the air pollution associated with industrialization
and to the Westernized lifestyle (Lindgren et al., 2009;
Tomac et al., 2005; Zuraimi, Tham, Chew, Ooi, &
David, 2008). Several particular environmental risk
factors such as exposure to indoor allergens, including pollens, fur of pets, smoking, heating systems,
and air pollution, have been reported to be risk factors to develop allergic diseases (Asher & Dagli,
2004; English et al., 1999; Tomac et al.). A higher
prevalence of childhood allergic disease is also associated with living in areas of lower altitude (< 1,000 m),
higher mean annual temperature (> 15°C), and higher
humidity (Kurt et al., 2007). Particular geographical
features seem to be associated with the development
of allergic diseases (Lindgren et al., 2009; Tomac
et al.; Zuraimi et al., 2008). Thus, geographical features should be assessed along with other known risk
factors, such as age, gender, and home environment;
few studies have investigated the influence of geography on childhood allergic diseases. This study examined the geographical distribution of childhood
allergic diseases in Korea and identified geographical
and sociodemographic risk factors for allergic diseases
in children. The results of this study should assist
public health nurses in better understanding how the
environment including geographic location may
affect a child’s health in relation to allergic diseases.
The research questions of this study were (a) what
is the geographical distribution of the three childhood allergic diseases such as asthma, allergic rhinitis, and atopic dermatitis in Korea and (b) how the
2
geographical and sociodemographic risk factors, including age, gender, comorbidity of allergic disease,
presence of indoor smokers and housing type are associated with the incidence of childhood allergic disease.
METHODS
Study sample and data
In 2009, the population of South Korea was estimated
to be approximately 49.0 million. About 70% of
South Korea’s land area (100,032 km2) is mountainous, and thus, highly densely populated areas are
concentrated in several metropolitan cities, such as
Seoul and Pusan, and Gyeonggi province, in the
lowland areas.
Data for this study were obtained from the Third
Korea National Health and Nutrition Examination
Survey (KNHNES III) conducted in 2005. This
national survey included a basic household and health
interview, a medical examination, and a nutrition survey. As the KNHSNES III uses a stratified multistage probability sampling method, with selections
made from sampling units based on geographical
area, sex, and age groups using household registries,
the KNHSNES III data represent the entire Korean
population in both urban and rural areas and in all
types of housing. For the survey, trained interviewers
visited each selected household and interviewed a
member of the household using the structured survey
questionnaire. The most frequent respondent for
the interview was the wife/mother for the family in
the survey.
Of a total of 34,145 participants who completed
the health interview, 8,631 participants who were
less than 19 years of age were included in this study.
Their age, gender, housing type (house vs. high-rise
apartment), and existence of a family member who
smokes at home were obtained from the KNHNES
III. The allergic disease status in this study was defined
by a “yes” response to the following question: “Has
your child had asthma diagnosed by a physician during his/her lifetime?” and “Has your child had allergic
rhinitis (and/or atopic dermatitis) diagnosed by a
physician during the past 12 months?”
Asian Nursing Research ❖ March 2011 ❖ Vol 5 ❖ No 1
Risk Factors for Allergic Diseases
Analytical strategy
Geographic information systems (GIS) have been
extensively used to map the incidence of disease and
to locate environmental risk factors in relation to geographical areas at both the state and national level
(Cromley & McLafferty, 2002; Choi, Afzal, & Sattler,
2006). Because the original KNHNES III does not
provide detailed information for GIS analysis in order
to keep individual health information confidential,
administrative district information of each child
which is appeared in the original dataset was used to
locate the geographical area of the child. Geographical areas under the same administrative unit of GIS
were combined to represent geographical unit data
for the study analysis. To map the incidence of allergic
diseases to geographical area of Korea, administrative district electronic maps provided by the Korean
National Geographic Information Institute were then
used (Shin & Um, 2006). The longitude and latitude for each geographical unit were identified using
ArcView 3.3 (Environmental Systems Research
Institute Inc., Redlands, CA, USA, 2003) GIS software program. To estimate risk ratios for childhood
asthma, allergic rhinitis, and atopic dermatitis in a
cluster, the number of children by each allergic disease and total number of children surveyed were
calculated according to geographical units. The risk
ratios and the total number of children for the three
allergic diseases (individually and combined) were
then used as an input for SaTScan version 8.0 software program (Kulldorff & Information Management
Services, 2009). The SaTScan software was originally
developed by Martin Kulldorff to perform geographical surveillance of disease, to detect areas of significantly high or low rates. This program is also able to
identify statistically significant spatial disease clusters
using chi-square tests, allowing the assessment of potential spatial epidemiological risk factors. Finally,
multiple logistic regression analysis was used to identify significant risk factors, including the geographical
cluster information for each allergic disease in Korean
children.
All statistical analyses were conducted using SAS,
version 9.1 (SAS Institute Inc., Cary, NC, USA) and
STATA 10.0 to handle complex survey sampling
Asian Nursing Research ❖ March 2011 ❖ Vol 5 ❖ No 1
design and unequal weights. The prevalence of each
allergic disease was presented as percentages using
weighted sample. Survey logistic regression model
was used to estimate the odds ratios in order to examine the association between allergic diseases and other
risk factors.
RESULTS
Prevalence of allergic diseases
Table 1 presents the prevalence of allergic diseases
in children according to sociodemographic factors.
Of 8,631 children, 4,274 (49.5%) were 9 years or
under, and 4,463 (51.7%) were boys. The overall
prevalence of allergic diseases was 256 (3.15%) for
asthma, 1,203 (13.21%) for allergic rhinitis, and 1,379
(15.45%) for atopic dermatitis. Asthma and atopic
dermatitis were more prevalent in younger children
(≤ 9 years) than in older children (10–18 years).
Atopic dermatitis was more common in girls than in
boys. Both asthma and atopic dermatitis were more
prevalent in children living in high-rise apartments
than in children living in regular houses. Children
residing in homes with indoor smokers had more
allergic rhinitis than children living in homes with
no indoor smokers.
Geographical distribution of allergic diseases
Figure 1 shows the identified geographical clusters on
a map of South Korea. Three different symbols indicate areas with relatively high prevalence of certain
allergic diseases, for example, circle for asthma, diamond shape for allergic rhinitis, and heart shape for
atopic dermatitis. Childhood asthma was significantly
more prevalent in southeastern Korea, with 21 southeastern clusters identified. Cases of allergic rhinitis
were concentrated in northwestern Korea, with 70
clusters. The prevalence of atopic dermatitis was high
in one cluster, in northwestern Jeju Island.
Table 2 shows geographical risk regions where
prevalence of each allergic disease was relatively high,
the number of cases indicating the actual number of
children with respective allergic disease, and expected
cases calculated statistically. The expected cases
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H.J. Lee, G.S. Kim
Table 1
Prevalence of Allergic Diseases According to Sociodemographic Factors
Asthma
Characteristics
n (%)
n
%a
Allergic rhinitis
n
%a
Atopic dermatitis
n
%a
Age (yr)
≤9
10–18
4,274 (49.5)
4,357 (50.5)
145
111
3.49
2.78
578
625
11.13
15.48
920
459
21.45
8.92
Gender
Boy
Girl
4,463 (51.7)
4,168 (48.3)
163
93
3.81
2.46
711
492
15.04
11.30
641
738
14.30
16.66
256
1,203
1,379
78
30.47
78
61
7.29
5.93
61
292
29.12
24.24
292
20.72
Living in a high-rise apartment
Yes
No
4,434 (51.4)
4,197 (48.6)
139
117
3.40
2.85
695
508
12.90
13.59
721
658
15.58
15.31
Indoor smoking
Yes
No
1,028 (11.9)
7,603 (88.1)
39
217
.00
3.19
139
1,064
27.48
13.05
95
1,284
15.44
15.47
Total
8,631
256
3.15
1,203
13.21
1,379
15.45
Comorbidity
Asthma
Allergic rhinitis
Atopic dermatitis
a
This indicates weighted prevalence rate.
refer to the same number of inside and outside the
cluster when the null hypothesis is true, that is, when
the risk of inside and outside is same. In the Table 2,
annual rate per 100,000 is calculated based on the
average length of a year of 365.2425, taking leap years
into account and relative risk is the estimated risk
(the actual number of cases divided by the expected
within the cluster) divided by the estimated risk (the
actual divided by the expected outside the cluster)
outside the cluster. The log likelihood ratio testing
whether the geographical risk clusters is statistically
different from the other geographical cluster in terms
of incidence of allergic disease found that the geographical clusters for all three allergic diseases were
statistically significant with p of .003 for asthma,
.003 for allergic rhinitis, and .001 for atopic dermatitis. The p is calculated for the detected clusters
using computer simulations (Monte Carlo randomization) due to unknown probability distribution of
the clusters (Kulldorff, 2010). The Monte Carlo p is
4
the rank of the observed maximum log likelihood
ratio among the 999 maximum log-likelihood ratios
from the Monte Carlo replicates divided by 1,000
(Abrams, Kulldorff, & Keinman, 2006).
Table 3 shows whether or not living in geographical risk regions affect the incidence of allergic disease
using weighted chi-square tests on geographical risk
regions. All three allergic diseases were significantly
associated with living in certain geographical areas.
This indicates a strong association between living in
areas where is highly prevalent of an allergic disease
and development of an allergic disease.
Risk factors for allergic diseases
Table 4 shows the results of weighted multiple logistic regression analyses. Younger children (< 10 years)
were 2.86 times for atopic dermatitis than older children (10–18 years) whereas allergic rhinitis was 1.74
times more likely to be found in older children. Boys
were 1.39 times more likely to have allergic rhinitis
Asian Nursing Research ❖ March 2011 ❖ Vol 5 ❖ No 1
Risk Factors for Allergic Diseases
than girls. Children with one allergic disease were
more likely to have another allergic disease. Both living in a high-rise apartment and exposure to indoor
smoking were not associated with the incidence of
any allergic diseases. The odds ratios for geographical
area risk factors were 3.47 for asthma, and 9.74 for
atopic dermatitis when other risk factors were controlled for. In other words, children living in high
prevalence areas for asthma and atopic dermatitis
were more likely to have the respective allergic
disease than those living in other areas.
DISCUSSION
Asthma
Allergic rhinitis
Atopic dermatitis
Figure 1. Geographical distribution of childhood
allergic diseases in Korea.
This is the first study demonstrating the significant
relationship of geographical location as well as sociodemographic risk factors to the incidence of childhood allergic diseases using a nationally representative
sample of Korean children. The estimated prevalence
of allergic diseases was 3.15% for asthma, 13.21%
for allergic rhinitis, and 15.45% for atopic dermatitis in Korean children under age of 18. Compared to
Table 2
Geographical High Risk Areas for Allergic Diseases
Geographical risk region
No. of cases
Expected cases
Annual cases/100,000
Relative risk
Log likelihood ratio
Monte Carlo rank
p
Asthma
Allergic rhinitis
96, 95, 101, 98, 91,
100, 99, 93, 92, 97, 94,
79, 74, 75, 83, 72, 71,
84, 57, 176, 175
44
20.28
6,418.3
2.41
11.59
3/1,000
228, 227, 226, 218, 219, 225, 102,
220, 104, 105, 103, 107, 106, 35,
217, 216, 48, 73, 46, 47, 221, 40, 12,
13, 24, 29, 53, 26, 25, 71, 72, 81, 41,
27, 52, 213, 214, 223, 5, 224, 21, 6,
7, 32, 23, 37, 39, 42, 22, 203, 36,
204, 33, 34, 215, 38, 199, 160, 127,
159, 126, 49, 208, 50, 30, 198, 154,
31, 153, 128
491
402.39
16,965.7
1.22
14.21
3/1,000
22
5.89
59,499.0
3.73
12.97
1/1,000
.003
.003
.001
Asian Nursing Research ❖ March 2011 ❖ Vol 5 ❖ No 1
Atopic dermatitis
209
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H.J. Lee, G.S. Kim
Table 3
Prevalence of Allergic Diseases by Geographical Risk Region
Allergic diseases
High-risk region (weighted %)
Low-risk region (weighted %)
c2
p
0.62
6.49
2.53
90.36
16.073
<.001
5.05
27.44
8.16
59.35
4.678
<.05
0.19
0.13
15.27
84.42
9.459
<.01
Asthma
Yes
No
Allergic rhinitis
Yes
No
Atopic dermatitis
Yes
No
Table 4
Multiple Logistic Regression to Examine Sociodemographic and Geographical Risk Factors for Allergic Diseases
Asthma
Allergic rhinitis
Atopic dermatitis
Variable
OR
95% CI
OR
95% CI
OR
95% CI
Age (10–18 yr)
0.88
0.49–1.58
1.74*
1.26–2.40
0.35*
0.24–0.51
Gender (Boy)
1.54
0.86–2.75
1.39*
1.06–1.83
0.79
0.58–1.07
Comorbidity
Asthma
Allergic rhinitis
Atopic dermatitis
2.74*
1.47–5.09
2.70*
2.10*
1.44–5.05
1.15–3.85
2.04*
2.18*
1.09–3.80
1.46–3.26
2.14*
1.44–3.18
Living in a high-rise apartment
1.24
0.68–2.26
0.93
0.69–1.25
1.00
0.72–1.39
Exposure to indoor smoking
0.71
0.26–1.96
0.83
0.52–1.34
0.86
0.46–1.61
Living in high geographical risk area
3.47*
2.04–5.92
1.31
0.94–1.84
9.74*
7.56–12.54
Note. OR = odds ratio; CI = confidence interval.
*p < .05.
recent study on childhood prevalence of allergic diseases, which reported asthma, allergic rhinitis, and
atopic dermatitis in children aged 6–13 at 7.8%,
27.9%, and 28.2%, respectively (Jee et al., 2009), the
results of our study report somewhat lower prevalence. This may be attributed to the greater age ranges
in our study than in the other and differences in assessing atopic diseases. Jee et al. (2009) used data
from self-reported symptoms of allergy in elementary
school students while our study used the survey
answers to the question “Have you have been diagnosed any allergic diseases by physician during the
last year?” Thus, our data can be considered to be
6
based on doctor-diagnosed allergic disease, although
self-report measure was used. In general, prevalence
using doctor-diagnosed allergic disease is lower than
other measures, such as self-reported allergic symptoms. In addition, during the past decade, a nationwide campaign on awareness of childhood allergic
diseases has been carried out in Korea and this campaign might have contributed to people being aware
of symptoms of allergic diseases, resulting in the
increase in incidence of allergic disease symptoms.
The results of the present study show remarkable
geographical differences in the incidence of childhood
asthma in Korea. The highest prevalence of asthma
Asian Nursing Research ❖ March 2011 ❖ Vol 5 ❖ No 1
Risk Factors for Allergic Diseases
is shown in southeastern Korea, concentrated in
Daegu City and its surrounding areas, such as Ulsan.
The high prevalence of asthma in Daegu may be
explained by its geographical features; it is a large,
industrialized city located in a valley surrounded by
mountains. In general, the air flow in valleys is more
sluggish than it is over flat land or along coast; thus it
may result in atmospheric congestion and possibly an
elevation in the degree of air pollution (Meng et al.,
2010). Air pollution is often reported to be associated with morning cough, bronchitis, and respiratory
symptoms including asthma (Hirsch et al., 1999;
Lindgren et al., 2009). Daegu is often covered with
smoke because the industrial complex is located
at the entry point for seasonal winds (Shin & Um,
2006; Um & Shin, 2002). It is likely that these geographical features of Daegu, the valley formation
and the construction of industrial facilities, seem
to contribute to children’s vulnerability to asthma.
Ulsan, located in the coastal region, is another highly
industrialized area, where the big automobile factories are located, resulting in the highest air pollution
in Korea. A higher prevalence of asthma is reported
in coastal regions, which have relatively higher temperatures and humidity as well (Kurt et al., 2007).
Thus, these findings of high asthma prevalence in
Daegu and Ulsan are in line with the results of previous studies (Ciccone et al., 1998; Hirsch et al.,
1999; Jee et al., 2009).
When a geographical risk is included as a variable
in the logistic regression with sociodemographic risk
factors to identify the association with development
of asthma, only comorbidity and living in high geographical risk area are significantly associated with
the incidence of asthma in children. This is interesting
result because even after the known risk factors for
childhood asthma such as gender and indoor smoking
were adjusted for, geographical risk area was still found
to be significant to associate with asthma. Strachan,
Golding, and Anderson (1990) also reported regional
effects of current residence upon wheezing illness
using British children who experienced interregional
migration. Higher prevalence of wheeze among children was highly associated with living in a high risk
region, while there were no difference between region
Asian Nursing Research ❖ March 2011 ❖ Vol 5 ❖ No 1
of birth and prevalence of wheezing illness. Thus,
these studies stressed where to reside is a significant
factor for childhood asthma incidence and may
suggest that public health nurses be alert to assess
geographical factors as well as other known sociodemographic risk factors.
In terms of allergic rhinitis, the geographical clusters are mostly concentrated in the northwestern area
of Korea, an area of highly populated and densely
crowded cities, including the capital city Seoul, and
Gyeonggi province. These areas have undergone rapid
Westernization and economic development during
the past 2 decades, and there are newly constructed
high-rise apartments to resolve the housing problems
of the recent migrant population. Although the exact
cause of the effect that living in a newly constructed
apartment has on developing allergic diseases has to be
determined, Platts-Mills, Vervloet, Thomas, Aalberse,
and Chapman (1997) and Hirsch et al. (2000) pointed
out the increased prevalence of allergic sensitization
to indoor allergens occurred in the newly constructed
apartments, which are equipped with insulated windows and central heating. Venn et al.’s (2001) study
also showed strong positive associations between allergic symptoms and the domestic use of modern fuels
for cooking and heating in urban areas. Based on these
studies, it can be said, with caution, which living in
a high-rise apartment in a westernized city might be
associated with the development of childhood allergic diseases.
In the logistic regression, only older age and being
a boy are associated positively with allergic rhinitis.
Unlike asthma, allergic rhinitis was not associated with
living in high geographical risk area. Allergic rhinitis
was not associated with indoor smoking, although
higher prevalence showed in children living in homes
with indoor smokers in descriptive analysis. This finding was inconsistent with other studies that reported
that symptoms of allergic rhinitis were associated with
exposure to environmental tobacco smoke in young
children (Zuraimi et al., 2008). Although a few
metropolitan cities show significantly higher prevalence in the geographical distribution of allergic
rhinitis in Korea, allergic rhinitis in this study seems
to be less correlated with environmental factors.
7
H.J. Lee, G.S. Kim
In our study, one specific geographic area in the
geographical distribution shows a high prevalence for
atopic dermatitis. The children living in Aeweol area
were nearly 10 times more likely to be developed
atopic dermatitis than children living in all other areas
of Korea. Aeweol is located on the north side of Jeju
Island, which is the biggest island in Korea and is less
industrialized than other parts of Korea; thus it retains
its natural beauty. Because Aeweol is a very small
village with a population of 25,000 in 201.88 km2
and is located near a harbor, the causative factor in
the development of atopic dermatitis living in this
area may possibly be related to environmental hazards, such as the harbor or perinatal exposure to
allergens, although this phenomenon remains to be
investigated. Bae and Shin (2009) reported that the
students who had atopic dermatitis in Jeju had a
higher number of recurrences compared with the students in other communities, however they did not
provide explanation about why a higher recurrence
rate of atopic dermatitis was noted.
Interestingly, among risk factors for atopic dermatitis, including younger age, comorbidity, and living
in geographical risk region, living in geographical risk
region had relatively the strongest relation with the
development of atopic dermatitis in Korean children
(odds ratio = 9.74). This finding suggests that other
possible factors in terms of geographical area need to
be investigated for atopic dermatitis incidence and to
develop preventive interventions for children living
in that area as well.
In this study, strong associations between comorbidity of allergic diseases were also found. The fact
that children with one allergic disease are more likely
to have other allergic diseases may in part support the
role that genetic influences play in developing allergic
diseases. Gustafsson, Sjoberg and Foucard (2000)
showed that among children with atopic dermatitis
at 3 years of age, 43% developed asthma and 45%
developed allergic rhinitis during the 4-year followup period. Hamouda, Karila, Connault, Scheinmann,
and de Blic (2008) found that 58.7% of the asthmatic
children in their sample also had allergic rhinitis,
and they stressed that allergic rhinitis and asthma
were frequently associated. Lee and Hwang (2008)
8
confirmed that Korean children with asthma or
allergic rhinitis were 1.6 times more likely to have
atopic dermatitis.Allergic diseases in regions with high
prevalence may also be attributed to genetic background by exposure of parents to different environmental allergenic factors that are then passed on to
their children. Thus, the risk factors for developing
childhood allergic diseases should include genetic
and sociodemographic factors as well as geographical
area factors.
There are several limitations to this study. As this
study was a cross-sectional study design, it is difficult
to assess if geographical area risk is associated with
the onset of allergic diseases or only triggers an existing allergic disease. The fact that the data were obtained from respondents to interviews, mostly by the
mother, instead of medical records can be a limitation
of the study. Although the interviewers were trained
in advance in how to collect data and how to ask
questions using the same questionnaire, we could not
control interrater reliability. Because this study did
not include detailed environmental characteristics of
the regions, further study is recommended to address
the precise etiology of factors contributing to disease
in relation to the characteristics of the regions that
have a high prevalence of these diseases.
CONCLUSIONS
The results of this study distinctly demonstrate the
existence of high-risk areas for physician-diagnosed
allergic diseases in Korean children and a significant
association with geographical areas in explaining in the
incidence of childhood asthma and atopic dermatitis. Each of the three allergic diseases was found to
be distributed in the respective region, and thus, the
distribution of diseases may be related to environmental hazards that may contribute to differences in
the prevalence of allergic diseases in Korea.
The results of this study suggest that public health
nurses should assess environmental factors of the
area as well as other known sociodemographic risk
factors when caring for children with allergic diseases,
and they should plan prevention programs that take
Asian Nursing Research ❖ March 2011 ❖ Vol 5 ❖ No 1
Risk Factors for Allergic Diseases
geographical epidemiological risk characteristics into
account. Identification of geographical risk areas
has been targeted in efforts to prevent the spread of
disease because environmental factors not only affect
large portions of the population, but are also modifiable. As shown in this study, Aeweol, a village on
Jeju Island, deserves an investigation of environmental features that are potentially associated with allergic diseases in children. Policy on environmental
health, including air quality, toxic waste, and healthy
homes and communities, also needs to be developed
based on the characteristics of each region. Public
health nurses should play an important role in continuously monitoring indoor and outdoor environments that may affect the incidence of childhood
allergic disease. Considering the risk of particular
geographical areas, national initiatives and further
study could be suggested to prevent allergic diseases
in these populations and geographical areas.
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