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Day care attendance, recurrent respiratory tract infections and asthma
W Nystad1, A Skrondal, P Magnus
1Section of Epidemiology, Department of Population Health Sciences, National Institute of Public Health, Oslo, Norway. wenche.nystad@folkehelsa.no
Objective:
Our objective was to use a causal model for childhood asthma to determine whether the effect of day care attendance on asthma was mediated by recurrent respiratory tract infections.
Design:
A cross-sectional survey among 1447 children aged 6-16 years in Oslo. Their parents completed written questionnaires. A recursive logit model was used to estimate direct effects in terms of adjusted odds ratios (aOR).
Results:
Year of birth, number of siblings and length of maternal education were significantly associated with day care attendance. Attendance at day care increased the risk of early infections, aOR = 1.8 (1.3-2.5), and infections were associated with asthma, aOR = 4.9 (3.4-7.3). The crude association between day care and asthma was cOR = 1.5 (1.0-2.2), whereas the estimated direct effect was small and nonsignificant, aOR = 1.2 (0.8-1.9). The results may be influenced by overreporting of infections among parents of children with asthma.
Conclusions:
Our results suggest that children who attend day care have an increased risk of asthma with early infections as a mediator of risk.