Mother’s education and offspring asthma risk in 10 European cohort studies

Abstract

Highly prevalent and typically beginning in childhood, asthma is a burdensome disease, yet the risk factors for this condition are not clarified. To enhance understanding, this study assessed the cohort-specific and pooled risk of maternal education on asthma in children aged 3–8 across 10 European countries. Data on 47,099 children were obtained from prospective birth cohort studies across 10 European countries. We calculated cohort-specific prevalence difference in asthma outcomes using the relative index of inequality (RII) and slope index of inequality (SII). Results from all countries were pooled using random-effects meta-analysis procedures to obtain mean RII and SII scores at the European level. Final models were adjusted for child sex, smoking during pregnancy, parity, mother’s age and ethnicity. The higher the score the greater the magnitude of relative (RII, reference 1) and absolute (SII, reference 0) inequity. The pooled RII estimate for asthma risk across all cohorts was 1.46 (95% CI 1.26, 1.71) and the pooled SII estimate was 1.90 (95% CI 0.26, 3.54). Of the countries examined, France, the United Kingdom and the Netherlands had the highest prevalence’s of childhood asthma and the largest inequity in asthma risk. Smaller inverse associations were noted for all other countries except Italy, which presented contradictory scores, but with small effect sizes. Tests for heterogeneity yielded significant results for SII scores. Overall, offspring of mothers with a low level of education had an increased relative and absolute risk of asthma compared to offspring of high-educated mothers.

Milk Other than Breast Milk and the Development of Asthma in Children 3 Years of Age. A Birth Cohort Study (2006-2011)

“…Mothers who have low levels of education can hardly get social support in addition to limited access to health information. Overall, this increases the exposure to risk factors that affects mothers and consequently their children health negatively [8,61].…”

“…Covariates were selected from the literature [6,7,16,17,[8][9][10][11][12][13][14][15]. Those related to the child included: whether stopped breastfeeding at <6 months of age, gender, delivered by caesarean section, low birth weight (weight<2500g), preterm delivery (gestational age <37 weeks), frequency of exposure to cigarettes smoke (derived from the question: "Indicate how regularly the baby is in a room or enclosed place where other people are smoking"), ever been diagnosed with eczema and ever diagnosed with food allergy.…”

“…Asthma has a broad spectrum of possible determinants extending from genetics to lifestyle to environmental factors [3]. Inherited factors hypothesized to be associated with the risk of asthma include: maternal asthma [6], young maternal age [7], low level of mother's education [8], Aboriginality [9] and child sex [10]. In addition, several prenatal and postnatal factors and early childhood exposures have been reported to contribute to the development of asthma in the offspring.…”

Vivência materna no cuidado da criança com asma [Mothers’ experience in caring for children with asthma] [Experiencia materna en el cuidado de niños con asma]

“…No entanto, o aparecimento da doença parece resultar da combinação da predisposição genética aos fatores ambientais, econômicos, demográficos, sociais e emocionais. Além destes, são elencados também como indutores da inflamação das vias aéreas, e o consequente desencadeamento de broncoespasmo, as mudanças climáticas, os alimentos, as drogas e o estresse emocional 5,11 .…”

“…Considerada a terceira causa de internações entre crianças, a asma apresenta tratamento complexo e exige a participação ativa do doente e dos familiares. Como, na DOI: http://dx.doi.org/10.12957/reuerj.2018.16983 infância, o paciente não possui autonomia para o autocuidado, o controle da doença é diretamente influenciado pelo cuidado exercido no ambiente domiciliar, especificamente na figura materna, que se constitui o principal determinante social da saúde na primeira infância 4,5 .…”