Pinot de Moira, Angela, Aurup, Anne V, Avraam, Demetris, Zugna, Daniela, Jensen, Aksel Karl Georg, Welten, Marieke, Cadman, Timothy, de Lauzon-Guillain, Blandine, Duijts, Liesbeth, Elhakeem, Ahmed et al (show 18 more authors)
(2025)
Understanding Social Inequalities in Childhood Asthma: Quantifying the Mediating Role of Modifiable Early-Life Risk Factors in Seven European Birth Cohorts
The Journal of Allergy and Clinical Immunology: In Practice, 13 (6).
pp. 1385-1396.
ISSN 2213-2198, 2213-2201
Abstract
Background: Children growing up in disadvantaged socioeconomic circumstances (SECs) have an increased risk of asthma. Objective: To increase our understanding of the pathways to inequalities in asthma and potential targets for intervention by (1) examining how the social patterning of asthma and its early-life risk factors varies across countries and (2) quantifying the mediation of observed inequalities by early-life risk factors. Methods: We used data for 107,884 mother-child dyads from 7 European birth cohorts across 6 countries. Maternal education was the primary exposure measure of early-life SECs. The outcome was current asthma in childhood (3-12 years). Inequalities were examined using multivariable regression and random effects meta-analysis. The mediating effects of early-life risk factors (maternal smoking during pregnancy, adverse birth outcomes, and breastfeeding duration) were examined using counterfactual mediation analysis. Results: In meta-analysis, children of mothers with low/medium versus high education had a 17% (95% confidence interval: 8%-27%, I<sup>2</sup> = 21.6%) increased risk of asthma. Cohort-specific risk ratios ranged between 1.07 (0.97-1.18, Danish National Birth Cohort, Denmark) and 1.61 (1.08-2.40, study on the pre- & early postnatal determinants of child health & development, France). The early-life risk factors were similarly socially patterned, but with greater heterogeneity across cohorts (I<sup>2</sup> range = 66.2%-95.3%). The mediation analysis suggested that these factors play a relevant role in mediating observed inequalities (proportion mediated range: 0.08-0.72). Conclusions: There was a consistent tendency for children from disadvantaged SECs to be at greater risk of asthma in the European cohorts examined. Our results suggest that early-life risk factors partially mediate these disparities and, therefore, that public health interventions in the perinatal period may help to address inequalities in asthma.
| Item Type: | Article |
|---|---|
| Additional Information: | Source info: THELANCETPUBLICHEALTH-D-24-00407 |
| Uncontrolled Keywords: | Childhood asthma, Socioeconomic, Inequalities, Birth cohort, Meta-analysis, Cross-cohort |
| Divisions: | Faculty of Health & Life Sciences Faculty of Health & Life Sciences > Inst. Population Health |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 06 May 2025 08:02 |
| Last Modified: | 23 May 2026 08:55 |
| DOI: | 10.1016/j.jaip.2025.02.032 |
| Open Access URL: | https://www.sciencedirect.com/science/article/pii/... |
| Related Websites: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3192611 |
| Disclaimer: | The University of Liverpool is not responsible for content contained on other websites from links within repository metadata. Please contact us if you notice anything that appears incorrect or inappropriate. |
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