{
  "abstract": "Introduction Asthma is a chronic respiratory disorder requiring ongoing medical management. This ecological study investigated the spatial and temporal patterns of notification rates for asthma from clinic visits and hospital discharges and identified demographic, meteorological and environmental factors that drive asthma in Bhutan.Methods Monthly numbers of asthma notifications from 2016 to 2022 were obtained from the Bhutan Ministry of Health. Climatic variables (rainfall, relative humidity, minimum and maximum temperature) were obtained from the National Centre for Hydrology and Meteorology, Bhutan. The Normalised Difference Vegetation Index (NDVI) and surface particulate matter (PM2.5) were extracted from open sources. A multivariable zero-inflated Poisson regression (ZIP) model was developed in a Bayesian framework to quantify the relationship between risk of asthma and sociodemographic and environmental correlates, while also identifying the underlying spatial structure of the data.Results There were 12 696 asthma notifications, with an annual average prevalence of 244/100 000 population between 2016 and 2022. In ZIP analysis, asthma notifications were 3.4 times (relative risk (RR)=3.39; 95% credible interval (CrI) 3.047 to 3.773) more likely in individuals aged >14 years than those aged ≤14 years, and 43% (RR=1.43; 95% CrI 36.5% to 49.2%) more likely for females than males. Asthma notification increased by 0.8% (RR=1.008, 95% CrI 0.2% to 1.5%) for every 10 cm increase in rainfall, and 1.7% (RR=1.017; 95% CrI 1.2% to 2.3%) for a 1°C increase in maximum temperature. An increase in one unit of NDVI and 10 µg/m 3 PM2.5 was associated with 27.3% (RR=1.273; 95% CrI 8.7% to 49.2%), and 2.0% (RR=1.02; 95% CrI 1.0% to 4.0%) increase in asthma notification, respectively. The high-risk spatial clusters were identified in the south and southeastern regions of Bhutan, after accounting for covariates.Conclusion Environmental risk factors and spatial clusters of asthma notifications were identified. Identification of spatial clusters and environmental risk factors can help develop targeted interventions that maximise impact of limited public health resources for controlling asthma in Bhutan.",
  "authors": [
    {
      "affiliations": [
        "National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia",
        "Royal Centre for Disease Control, Ministry of Health, Thimphu, Bhutan"
      ],
      "name": "Tsheten Tsheten"
    },
    {
      "affiliations": [
        "National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia"
      ],
      "name": "Dan Château"
    },
    {
      "affiliations": [
        "National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia"
      ],
      "name": "Erin Walsh"
    },
    {
      "affiliations": [
        "National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia"
      ],
      "name": "Ginny Sargent"
    },
    {
      "affiliations": [
        "Queen’s University Belfast, Northern Ireland, UK"
      ],
      "name": "Archie C A Clements"
    },
    {
      "affiliations": [
        "QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia"
      ],
      "name": "Darren Gray"
    },
    {
      "affiliations": [
        "National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia"
      ],
      "name": "Matthew Kelly"
    },
    {
      "affiliations": [
        "Ministry of Health, Punakha District Hospital, Punakha, Bhutan"
      ],
      "name": "Nima Dorji"
    },
    {
      "affiliations": [
        "Department of Public Health, Ministry of Health, Thimphu, Bhutan"
      ],
      "name": "Phurpa Tenzin"
    },
    {
      "affiliations": [
        "Royal Centre for Disease Control, Ministry of Health, Thimphu, Bhutan"
      ],
      "name": "Lila Adhikari"
    },
    {
      "affiliations": [
        "Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan"
      ],
      "name": "Kinley Penjor"
    },
    {
      "affiliations": [
        "University of Canberra, Canberra, Australian Capital Territory, Australia"
      ],
      "name": "Nasser Bagheri"
    },
    {
      "affiliations": [
        "University of Canberra, Canberra, Australian Capital Territory, Australia"
      ],
      "name": "Kinley Wangdi"
    }
  ],
  "title": "Spatiotemporal patterns of asthma in Bhutan: a Bayesian analysis",
  "uid": "29b6a406-bac4-5b3d-a248-98ac41abfcc4"
}