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Parental socioeconomic status, childhood asthma and medication use--a population-based study
Tong Gong1, Cecilia Lundholm1, Gustaf Rejnö1
1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Insights
Parental income and education significantly impact childhood asthma risk and medication use. Lower socioeconomic status is linked to higher early-life asthma risk but lower risk later on, while lower parental education consistently increases asthma incidence and healthcare utilization.
Area of Science:
- Pediatric Allergy and Immunology
- Public Health Research
- Socioeconomic Determinants of Health
Background:
- Parental socioeconomic status (SES) is a critical factor in child health outcomes, yet its specific influence on childhood asthma risk and healthcare utilization remains underexplored.
- Understanding the relationship between parental income and education and childhood asthma is crucial for developing targeted public health interventions.
Purpose of the Study:
- To investigate the association between parental socioeconomic status (income and education) and the risk of childhood asthma.
- To examine the relationship between parental SES and healthcare and medication use among children diagnosed with asthma.
Main Methods:
- A large-scale, register-based cohort study involving 211,520 children born between April 2006 and December 2008, with follow-up until December 2010.
- Utilized national registers for asthma diagnoses and dispensed medications, linked with parental income and education data from Statistics Sweden.
- Employed Cox proportional hazard regression to analyze associations between parental SES and asthma-related outcomes.
Main Results:
- Children with lower parental income exhibited an increased risk of asthma diagnosis and medication use in the first year of life, with a reversed trend observed in later childhood.
- Lower parental education was consistently associated with a higher risk of childhood asthma incidence, including inpatient and outpatient diagnoses.
- Children from families with lower educational attainment were prescribed fewer controller medications for asthma compared to those with college-educated parents.
Conclusions:
- Parental income demonstrates an age-dependent association with childhood asthma risk, while parental education shows a consistent inverse relationship with asthma incidence and healthcare utilization.
- These findings highlight the significant role of socioeconomic factors in childhood asthma and underscore the need for further investigation and intervention strategies to address health disparities.
Background:
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.
Methods:
This 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.
Results:
Compared 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.
Conclusions:
Our 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.
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