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Social adversity, migration and hospital admissions for childhood asthma in Sweden
A Hjern1, B Haglund, S Bremberg
1Department of Clinical Sciences, Huddinge University Hospital, Karolinska Institutet, Stockholm, Sweden. anders.hjern@sos.se
Insights
Hospital admissions for childhood asthma are higher in socially disadvantaged families and single-parent households. Smoking during pregnancy also increases asthma admission risk in young children.
Area of Science:
- Pediatrics
- Public Health
- Epidemiology
Background:
- Childhood asthma prevalence is increasing, yet hospital admissions have decreased in Sweden.
- Improved maintenance therapy for severe childhood asthma is a potential explanation for decreased admissions.
- Socioeconomic and ethnic factors influencing asthma hospitalizations require further investigation.
Purpose of the Study:
- To identify social and ethnic characteristics of children (2-18 years) requiring improved asthma disease management.
- To analyze risk factors for hospital admission due to asthma in children.
- To investigate disparities in asthma care and outcomes.
Main Methods:
- Utilized Swedish National Patient Discharge Registers for hospital admissions data (Stockholm, Malmö, Gothenburg, 1990-1994).
- Analyzed data for children aged 2-18 years, focusing on social welfare status, household structure, and ethnicity.
- Calculated adjusted odds ratios (OR) to determine risk factors for asthma-related hospital admissions.
Main Results:
- Children in families on social welfare and single-parent households had higher odds of asthma hospital admission (OR: 1.3-1.5).
- Children on social welfare faced a particularly high risk of multiple annual admissions (OR: 1.6-2.9).
- Exposure to smoking during pregnancy increased asthma admission risk in children under 3 years.
- Children born outside Western countries, USA, and Australia, and Swedish-born children with mothers from Eastern/Southern Europe had lower asthma admission risks (OR: 0.1-0.6).
Conclusions:
- Socially disadvantaged children, particularly those in single-parent households, require targeted asthma management strategies.
- Prenatal smoking exposure is a significant risk factor for childhood asthma hospitalizations.
- Ethnic variations in asthma prevalence may exist, necessitating further research into underlying factors and potential disparities in healthcare access or disease presentation.
Abstract:
The number of children admitted to hospitals because of asthma has been reported to decrease in Sweden in recent decades despite an increasing prevalence of childhood asthma. This decrease has been explained by improved maintenance therapy of children with severe asthma. In this study we used data on hospital admissions for asthma from the Swedish National Patient Discharge Registers in Stockholm, Malmö and Gothenburg 1990-1994 to identify social and ethnic characteristics of children 2-18-y-old in need of improvement in disease management. Children in families on social welfare (adjusted odds ratios (OR): 1.3 and 1.5) and children in single-parent households (adjusted OR: 1.3 and 1.4) were more often admitted to hospital because of asthma at least once during a calendar year in the 2-6- and 7-18-y-old groups. Children in families on social welfare had a particularly high risk of being admitted more than once during a calendar year (adjusted OR: 1.6 in the younger age group and 2.9 in the older group). Exposure to smoking during pregnancy was more common in socially disadvantaged families and increased the risk of hospital admission in children below 3 y of age. Children born outside Western Europe, the USA and Australia were less commonly admitted to hospital because of asthma than other children in the population (adjusted OR: 0.1-0.5). Swedish-born children with mothers who were born in Eastern and Southern Europe were also at lower risk for admission to hospital with a diagnosis of asthma (adjusted OR: 0.2-0.6). This probably indicates a lower prevalence of asthma in these ethnic groups. Further studies are needed to identify factors that can explain these ethnic differences in childhood asthma.