Disparate geographic prevalences of asthma, allergic rhinoconjunctivitis and atopic eczema among adolescents in five Canadian cities.

To assess concordance of prevalence rates of asthma, allergic rhinoconjunctivitis and atopic eczema symptoms among adolescents in five Canadian cities. The International Study of Asthma and Allergies in Childhood Phase 3 written questionnaires were answered by 8334 adolescents aged 13 to 14 in Vancouver, Saskatoon, Winnipeg, Hamilton and Halifax, Canada. Prevalence rates of current symptoms ranged from 13.7-33.0% for wheezing, 14.6-22.6% for allergic rhinoconjunctivitis and 8.2-10.4% for atopic eczema. Using Hamilton as reference, the prevalence of wheezing was significantly higher in Halifax (OR = 1.58; 95% CI 1.36-1.84) and Saskatoon (1.27; 1.07-1.50) and significantly lower in Vancouver (0.51; 0.44-0.59). In contrast, allergic rhinoconjunctivitis was significantly more prevalent in Winnipeg (1.39; 1.16-1.68) and Halifax (1.36; 1.14-1.61) and trended lower in Saskatoon (0.81; 0.66-1.00). Atopic eczema was significantly more prevalent in Winnipeg (1.31; 1.01-1.69) and Vancouver (1.28; 1.04-1.58). Multivariable logistic regression analyses showed the region of residence, being born in Canada, recent use of acetaminophen and heavy exposure to traffic exhaust were significantly associated with all three allergic conditions, while obesity and having two or more smokers at home was only associated with increased risk for wheezing. Chinese ethnicity decreased that risk. Among five Canadian centres, the highest prevalence rates of allergic rhinoconjunctivitis or atopic eczema were not observed in the same regions as the highest prevalence rates of wheezing. This disparity in regional variations in the prevalence rates suggests dissimilar risk factors for the development or expression of wheezing (asthma), allergic rhinoconjunctivitis and atopic eczema.

The demographic bias of email as a survey method in a pediatric emergency population.

UNLABELLED: Email has been considered as a communication medium between patients and clinicians in pediatric emergency departments, but the demographic bias involved in using email has not been fully explored. We developed a paper based survey to explore access, willingness to participate and the demographic bias of email within our parent population. METHODS: To 1733 possible subjects, 1200 surveys were distributed with a return of 1018, a survey response rate of 85%, and a population response rate of 59%. RESULTS: Subjects from families with incomes less than $60,000 per year had lower access rates (OR = 0.40, 95 (OR = 0.37, [0.17, 0.81]). Employment outside of the home was associated with increased email access rates (OR = 1.79, 95% CI [1.19, 2.70]). Visible minority status was associated with an increased willingness to participate (OR = 1.84, 95 as was low education (OR = 2.12, 95% CI [1.04, 4.32]). The population of theoretical responders to an email based quality assurance process would have been significantly different from the base population of adults accompanying children to our emergency department as a result of these biases. CONCLUSIONS: We have demonstrated a degree of demographic bias in email access rates, negatively affecting those individuals with lower income, less employment, and lower education. Email based surveys directed at parents in pediatric emergency departments should include questions on income, employment and education in order to permit those who analyze the data to correct for these variables. More research is needed to confirm these findings.

The demographic bias of Email as a survey method in a pediatric emergency population.

UNLABELLED: Email has been considered as a communication medium between patients and clinicians in pediatric emergency departments, but the demographic bias involved in using email has not been fully explored. We developed a paper based survey to explore access, willingness to participate and the demographic bias of email within our parent population. METHODS: To 1733 possible subjects, 1200 surveys were distributed with a return of 1018, a survey response rate of 85%, and a population response rate of 59%. RESULTS: Subjects from families with incomes less than $60,000 per year had lower access rates (OR=0.40, 95% CI [0.25, 0.62]), as did those with lower education (OR=0.37, [0.17, 0.81]). Employment outside of the home was associated with increased email access rates (OR=1.79, 95% CI [1.19, 2.70]). Visible minority status was associated with an increased willingness to participate (OR=1.84, 95% CI [1.10, 3.06]) as was low education (OR=2.12, 95% CI [1.04, 4.32]). The population of theoretical responders to an email based quality assurance process would have been significantly different from the base population of adults accompanying children to our emergency department as a result of these biases. CONCLUSION: We have demonstrated a degree of demographic bias in email access rates, negatively affecting those individuals with lower income, less employment, and lower education. Email based surveys directed at parents in pediatric emergency departments should include questions on income, employment and education in order to permit those who analyze the data to correct for these variables. More research is needed to confirm these findings.