研究背景： 兒童呼吸道疾病是一個重要的議題，氣喘是兒童最常見的慢性疾病，呼吸道感染是兒童最常見的感染症之一。社經指標包括個人指標與地區指標，社經指標可能透過巨觀的經濟脈絡和社會因素去影響健康。隨著時代的變遷，社會不平等的問題日益增加，兒童呼吸道疾病盛行率有增加的趨勢，因此社經指標對兒童呼吸道疾病的影響更加重要。傳統上針對兒童氣喘的研究集中在個人層級的分析，較少注意到個人居住地區層級脈絡，多層級分析(multilevel analysis)以生態的觀點解釋氣喘在不同社經和地理異質性的表現。國外研究結果社會經濟指標與兒童氣喘無一致結論，過去很少文獻使用多層級模式研究兒童呼吸道疾病與社經指標的關係，而且台灣無相關於社會經濟指標與兒童呼吸道疾病的研究，因此使用多層級分析研究台灣社會經濟指標與兒童呼吸道疾病的關係。
研究對象與方法： 本研究是在2007年進行世代研究，藉由連接台灣兒童健康研究(Taiwan Children Health Study)與行政院經濟建設委員會2007年都市及區域發展統計彙編資料進行研究。台灣兒童健康研究共有14個縣市的14所國中進入研究，總共有12到14歲4,551個國中生進入研究。使用國際兒童氣喘與過敏研究問卷調查，依變項為孩童呼吸道疾病的盛行率，自變項為個人社經指標與地區社經指標。個人社經指標包括父母中最高教育程度與家庭年收入，教育程度以完成教育年限區分為三級：<12年；12-15年； ≧16年；家庭年收入區分為三級：40萬元以下；41萬元-80萬元；81萬元以上。地區社經指標是平均每戶全年經常性收入。統計方法是多層級模型分析。
結果： 過去12個月罹患支氣管炎的盛行率5.7%，醫師診斷氣喘的盛行率7.5%，氣喘症狀的盛行率11.8%。父母教育程度愈高則過去12個月罹患支氣管炎的盛行率愈高(完成教育年限：16年vs.<12年OR= 1.74,95%的信賴區間：1.07-2.84)，地區每年每戶平均經常性收入愈高則過去12個月罹患支氣管炎的盛行率愈高(OR= 1.96, 95%的信賴區間：1.15-3.32)。個人的家庭年收入愈高則氣喘症狀的盛行率愈高 (家庭年收入：≧81萬元vs.≦40萬元OR= 1.37 ,95%的信賴區間：1.30-1.81)。
結論： 台灣社經指標與兒童呼吸道疾病呈正相關，父母社經指標愈高則兒童呼吸道疾病的盛行率愈高。家庭年收入愈高則兒童氣喘症狀的盛行率愈高。考慮父母親過敏症、居家環境因子與個人社經指標，台灣兒童居住在高收入地區其支氣管炎的盛行率較高。

Background : Childhood respiratory diseases is an important problem. Childhood asthma is now the leading chronic disease of children among industrialized countries. Respiratory tract infection is one of the most common pediatric infectious diseases. Socioeconomic status (SES) includes individual and area-based indicators. There are multiple pathways by which SES determines health; a comprehensive analysis include macroeconomic contexts and social factors. Traditionally, asthma epidemiology has focused on individual-level risk factors. Far less attention has been given to the broader social context in which individuals live. A multilevel approach that explicitly recognized the ecological impact of asthma within its socioeconomic and geographic context. A number of studies on the association between childhood asthma and SES do not reveal a clear picture. Multilevel models have only rarely been used to explore how the socioeconomic status can impact childhood asthma. However, there was no study about the relationship between socioeconomic status and childhood respiratory diseases in Taiwan. The purpose of this paper is to analyze the relationship between SES and childhood respiratory diseases in Taiwan using a multilevel analysis.
Methods : We used dataset from Taiwan Children Health Study (TCHS) a baseline cohort carried out in 2007. Questionnaires including the International Study of Asthma and Allergies in Childhood (ISAAC) core module on wheeze, as well as questions about other respiratory symptoms, were completed by the parents of 4,551 schoolchildren aged 12-14 yrs, from 14 counties in Taiwan. Individual data on parents’ education and on childhood respiratory diseases were gathered from self administered parental questionnaires. Several area-based indicators in 2007 were derived using information available at the urban and regional Development Statistics of Taiwan. The parents’ education was defined by the finishing full-time studies completed by either the mother or the father: <12 years, 12-15 years, ≧16 years. Average current income per household were categorized into three groups: ≦400,000NT$;410,000-800,000 NT$;≧810,000 NT$ . The associations between respiratory disease and socioeconomic status were estimated by using multilevel analysis.
Results : The overall current bronchitis prevalence of our population was 5.7%, the prevalence of physician diagnosis of asthma was 7.5%, and ever wheeze was reported for 11.8% of the children. Current bronchitis prevalence was higher in higher socioeconomic groups, whether defined by educational level (odds ratio for finishing full-time studies—16 vs. 12 years = 1.74, 95% confidence interval: 1.07, 2.84).Prevalence of current bronchitis increased as average current income per household increased (odds ratio = 1.96, 95% confidence interval: 1.15, 3.32). Ever wheeze prevalence was higher in higher socioeconomic groups, whether defined by annual household income (odds ratio for annual household Income —≧810,000 NT$ vs. ≦400,000NT$ = 1.37, 95% confidence interval: 1.30, 1.81).
Conclusions : A positive association between socioeconomic status and childhood respiratory diseases prevalence was found. The prevalence of ever wheeze increased as annual household income increased .Our study also indicated that regardless of their personal SES, subjects living in counties with higher average current income per household level had higher risks of current bronchitis in Taiwan.

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