Prevalence of Allergic Rhinitis in China Continues to Increase Without Reaching a Plateau: An Analysis of Three Waves of National Surveys From 2005 to 2019

Allergic rhinitis (AR) is an important public health challenge worldwide, with a global prevalence of 10%–40% and more than 500 million people affected [1]. Over the past three decades, the global prevalence of AR has increased significantly, yet China still lacks systematic data on its long-term trends. This study aimed to provide reliable data on the prevalence trend of AR and associated factors in Chinese adults. This study is based on a comprehensive analysis of three serial cross-sectional surveys (2005, 2011, and 2019), with the 2019 data being newly conducted, including 18 cities from our previous surveys and nine new cities (Figure 1A). The telephone numbers were sampled using the same computerized random digit dialing method as in previous studies, and trained interviewers conducted telephone interviews with eligible individuals aged 16–65 years. We updated the questionnaire based on previous versions, retaining core AR diagnostic questions and adding items on associated factors and background information [2]. Related factors for AR were examined using multivariable regression and the population attributable fractions (PAFs) were subsequently calculated. This research proposal has been reviewed and approved by the Ethics Review Committee of Beijing Tongren Hospital, and verbal consent was obtained from all participants. More details of methods and analyses are in the Supporting Information. A total of 25,125 adults completed interviews and after adjustment for the age and sex distribution of each city, the standardized prevalence ranged from 14.2% (Chongqing) to 33.7% (Hohhot) in 2019. For each city, the trends in the prevalence of AR varied (Figure 1B). The average standardized prevalence of AR in 2019 was 20.9%, which was significantly greater than that in 2005 (11.1%) and 2011 (17.6%) (p < 0.001) (Table S1). To explore the associations between external factors and AR, we collected data on air pollution, meteorological conditions, ecological environment, socioeconomic status, and dietary structure in selected cities. The multivariate analysis demonstrated that the average annual income (β = 0.120, 95% confidence interval (95% CI) = [0.052, 0.190]) and vegetation coverage (β = 0.062, 95% CI = [0.026, 0.098]) were positively associated with AR prevalence, whereas humidity and temperature were negatively associated with it (β = −0.002, 95% CI = [−0.003, −0.001]; and β = −0.005, 95% CI = [−0.008, −0.002], respectively) (Table S2). Furthermore, we constructed a panel data ordinary least squares (OLS) regression model using data from the 11 cities surveyed across 2005, 2011, and 2019. In this analysis, the dependent variable was defined as the standardized prevalence of AR at each specific time point. The results showed the change in AR prevalence was associated with the average annual income, SO2 concentration, and vegetation coverage (β = 0.067, 95% CI = [0.033, 0.102]; β = 0.966, 95% CI = [0.218, 1.714]; and β = 0.058, 95% CI = [0.003, 0.119], respectively) (Table S3). The results of the multivariate analysis on the relationship between the family and personal conditions of the respondents and the AR prevalence showed that using antibiotics ≥ 3 times in the past year was strongly associated with AR (odds ratios (OR) = 5.810, 95% CI = [5.306, 6.363]). Being female (OR = 1.108, 95% CI = [1.027, 1.196]), having a higher level of education (OR = 1.436, 95% CI = [1.062, 1.942]), having a smoking father (OR = 1.148, 95% CI = [1.068, 1.235]), having dogs or cats (OR = 1.165, 95% CI = [1.081, 1.256]), per capita living area < 40 m2 (OR = 1.196, 95% CI = [1.116, 1.282]) and living in a house within 50 m of roads with heavy traffic (OR = 1.105, 95% CI = [1.031, 1.185]) were all weak to moderate associations for AR. The greatest attributable fraction of AR was observed for overuse of antibiotics (PAF = 47.23%) (Table 1). Our results revealed that the prevalence of AR in the Chinese population has increased continuously from 2005 to 2019. Additionally, our result of Hohhot closely matches a study reported in 2023, further confirming the continued representativeness of our findings [3]. Interestingly, frequent antibiotic use showed a significant association with the prevalence of AR, consistent with a Brazil study, suggesting that the public should use antibiotics rationally [4]. We also found that rising SO2 emissions accompanying rapid modernization were significantly associated with a higher prevalence of AR [5]. Crowded housing conditions, which often impair ventilation and allow indoor allergens to accumulate, were likewise correlated with AR [6]. However, this study has several limitations. The main constraint is the lack of objective clinical data, such as allergen testing, to verify the accuracy of AR identification. Additionally, other potential limitations, including reverse causation, are detailed in the Supporting Information. In summary, this study is the first to reveal that the prevalence of AR in China has nearly doubled over the past 15 years and to quantify its associations with related factors, offering targeted insights to AR. M.Z., X.W. and L.Z. conceived and designed the study. S.G., M.Z. and X.P. did all the statistical analyses. All authors contributed to data collection and curation. Y.S., X.Y. and Z.W. accessed and verified the underlying data. X.P. drafted the manuscript. All authors had access to the data, approved the final version of the manuscript, and accept responsibility for the decision to submit for publication. We thank all staff for making phone interviews and all participants for their support during the study. This work was supported by grants from the Beijing Scientific and Technological Overall Plan of Beijing Municipal Health Commission (Z171100000117002), High Level Public Health Technical Talent Training Plan (Lingjunrencai-01-08 and Lingjunrencai-02-09), National Natural Science Foundation of China (82371115, 82171110 and 82471137), National Key R&D Program of China (2022YFC2504100), Program for the Changjiang Scholars and Innovative Research Team (IRT13082), Beijing Natural Science Fund (7222024), CAMS Innovation Fund for Medical Sciences (2019-I2M-5-022), Beijing Municipal Science and Technology Project (Z181100001618002), and Beijing New-Star Plan of Science and Technology (20220484226 and 20230484476). This research proposal has been reviewed and approved by the Ethics Review Committee of Beijing Tongren Hospital. Since it was an anonymous questionnaire, personal information of the participants was not recorded. Participation in the survey was voluntary; then written informed consent from the participants was not needed, and verbal consent was obtained from all participants. The authors declare no conflicts of interest. The data that support the findings of this study are available from the corresponding author upon reasonable request. Table S1: The prevalence of self-reported AR in China among 2005, 2011, and 2019. Table S2: Multivariable analysis of the protective and related factors affecting the prevalence of self-reported AR in 2019. Table S3: Multiple analysis of socioeconomic and environmental factors associated with the tendency of self-reported AR prevalence. Table S4: Data on air pollution, meteorological conditions, and socioeconomic statuses in 11 out of 27 cities among 2005, 2011 and 2019. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. 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