Author:
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Lewis, Kate Marie; Ruiz, Milagros; Goldblatt, Peter; Morrison, Joana; Porta, Daniela; Forastiere, Francesco; Hryhorczuk, Daniel; Zvinchuk, Oleksandr; Saurel-Cubizolles, Marie-Josephe; Lioret, Sandrine; Annesi-Maesano, Isabella; Vrijheid, Martine; Torrent, Maties; Iniguez, Carmen; Larranaga, Isabel; Harskamp-van Ginkel, Margreet W.; Vrijkotte, Tanja; Klanova, Jana; Svancara, Jan; Barross, Henrique; Correia, Sofia; Jarvelin, Marjo-Riitta; Taanila, Anja; Ludvigsson, Johnny; Faresjo, Tomas; Marmot, Michael; Pikhart, Hynek
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Abstract:
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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. |