Thorax 66:1043-1050 doi:10.1136/thoraxjnl-2011-200225
  • Asthma and the environment
  • Original article

Urbanisation is associated with prevalence of childhood asthma in diverse, small rural communities in Ecuador

Open Access
  1. Philip J Cooper1,4,5,6
  1. 1Laboratorio de Investigaciones FEPIS, Quinindé, Esmeraldas, Ecuador
  2. 2Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
  3. 3Department of Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
  4. 4Molecular and Biochemical Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK
  5. 5Colegio de Ciencias de la Salud, Universidad San Fransisco de Quito
  6. 6Centre for Infection, St George's University of London, London, UK
  1. Correspondence to Professor Alejandro Rodríguez, Centro de Investigaciones FEPIS (Fundación Ecuatoriana para la Investigación en Salud), Quinindé, Esmeraldas, Ecuador; rodriguez_alejo1{at}
  1. Contributors Study design: PJC, AR, MC, LCR, MLB. Data collection; AR, MV, GO, SE. Data analysis: AR,CT. Draft manuscript: AR, PJC. Manuscript review: AR, PJC, LR, MLB.

  • Received 19 March 2011
  • Accepted 13 June 2011
  • Published Online First 8 August 2011


Background Studies conducted in transitional communities from Africa and Asia have pointed to the process of urbanisation as being responsible for the increase in asthma prevalence in developing regions. In Latin America, there are few published data available on the potential impact of urbanisation on asthma prevalence. The aim of the present study was to explore how the process of urbanisation may explain differences in asthma prevalence in transitional communities in north-eastern Ecuador.

Methodology/principal findings An ecological study was conducted in 59 communities in Esmeraldas Province, Ecuador. Indicators of urbanisation were grouped into three indices representing the processes associated with urbanisation: socioeconomic, lifestyle and urban infrastructure. Categorical principal components analysis was used to generate scores for each index and a fourth index—a summary urbanisation index—was derived from the most representative variables in each of the three indices. The authors analysed the associations between community asthma prevalence and the indices, as well as with each indicator variable of every group. The overall prevalence of asthma was 10.1% (range 0–31.4% between communities). Three of the four indices presented significant associations with community asthma prevalence: socioeconomic (r=0.295, p=0.023), lifestyle (r=0.342, p=0.008) and summary urbanisation index (r=0.355, p=0.006). Variables reflecting better socioeconomic status and a more urban lifestyle were associated with greater asthma prevalence.

Conclusions These data provide evidence that the prevalence of asthma increases with increasing levels of urbanisation in transitional communities, and factors associated with greater socioeconomic level and changes towards a more urban lifestyle may be particularly important.


  • See Editorial, p 1025

  • Funding Wellcome Trust, UK, HCPC Latin American Centres of Excellence Programme (ref 072405/Z/03/Z). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

  • Competing interests None.

  • Ethics approval The study protocol was approved by the ethics committee of the Hospital Pedro Vicente Maldonado, Ecuador.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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