Abstract
BackgroundLittle is known about how parental socioeconomic status affects offspring asthma risk in the general population, or its relation to healthcare and medication use among diagnosed children.MethodsThis register-based cohort study included 211,520 children born between April 2006 and December 2008 followed until December 2010. Asthma diagnoses were retrieved from the National Patient Register, and dispensed asthma medications from the Prescribed Drug Register. Parental socioeconomic status (income and education) were retrieved from Statistics Sweden. The associations between parental socioeconomic status and outcomes were estimated by Cox proportional hazard regression.ResultsCompared to the highest parental income level, children exposed to all other levels had increased risk of asthma during their first year of life (e.g. hazard ratio, HR 1.19, 95% confidence interval, CI 1.09–1.31 for diagnosis and HR 1.17, 95% CI 1.08–1.26 for medications for the lowest quintile) and the risk was decreased after the first year, especially among children from the lowest parental income quintile (HR 0.84, 95% CI 0.77–0.92 for diagnosis, and HR 0.80, 95% CI 0.74–0.86 for medications). Further, compared to children with college-educated parents, those whose parents had lower education had increased risk of childhood asthma regardless of age. Children with the lowest parental education had increased risk of an inpatient (HR 2.07, 95% CI 1.61–2.65) and outpatient (HR 1.32, 95% CI 1.18–1.47) asthma diagnosis. Among diagnosed children, those from families with lower education used fewer controller medications than those whose parents were college graduates.ConclusionsOur findings indicate an age-varying association between parental income and childhood asthma and consistent inverse association regardless of age between parental education and asthma incidence, dispensed controller medications and inpatient care which should be further investigated and remedied.
Highlights
Asthma is the most prevalent chronic disease among children and is associated with morbidity, substantial healthcare resource use and parental absence from work [1,2]
In this study we investigated whether parental income and education were associated with the risk of childhood asthma in a nationwide register-based cohort of preschool children
We investigated whether parental income and education were associated with an inpatient or outpatient diagnosis and use of controller medications among all diagnosed children identified from the cohort
Summary
Asthma is the most prevalent chronic disease among children and is associated with morbidity, substantial healthcare resource use and parental absence from work [1,2]. Several studies have tried to explain how socioeconomic status (SES) influences the development of asthma but with discrepant results. Most studies have reported that children in families with low SES (measured by parental occupation, education or family income), have an increased asthma risk even after adjustment for known confounders such as prenatal maternal smoking, indoor allergens, and maternal stress [7,8,9]. Little is known about how parental socioeconomic status affects offspring asthma risk in the general population, or its relation to healthcare and medication use among diagnosed children
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