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Social inequalities in wheezing in children: findings from the UK Millennium Cohort Study
David C Taylor-Robinson1, Anna Pearce2, Margaret Whitehead3
1Dept of Public Health and Policy, University of Liverpool, Liverpool, UK UCL Institute of Child Health, London, UK dctr@liv.ac.uk.
Insights
Socioeconomic factors influence childhood wheezing. Adjusting for maternal smoking during pregnancy and breastfeeding eliminated social inequalities in wheezing, suggesting targeted policies could reduce disparities in childhood asthma.
Area of Science:
- Pediatric respiratory health
- Social epidemiology
- Public health
Background:
- Childhood wheezing exhibits social patterning, but the underlying explanatory factors remain unclear.
- Socioeconomic disparities in wheezing prevalence necessitate investigation into mediating factors.
Purpose of the Study:
- To analyze the relationship between socioeconomic circumstances and childhood wheezing phenotypes.
- To identify maternal, antenatal, and early-life factors that mediate socioeconomic inequalities in wheezing.
Main Methods:
- Regression analysis of the UK Millennium Cohort Study (11,141 children).
- Multinomial regression used to estimate relative risk ratios for early and persistent/relapsing wheeze.
- Assessment of maternal education, smoking during pregnancy, and breastfeeding as potential mediators.
Main Results:
- Children of mothers with no educational qualifications had higher risks for both early and persistent/relapsing wheeze.
- Controlling for maternal smoking during pregnancy and breastfeeding eliminated the elevated wheezing risk associated with lower socioeconomic status.
- Male sex, maternal age, BMI, atopy, smoking, preterm birth, breastfeeding, and early exposures were independently associated with wheezing, with varying patterns.
Conclusions:
- Socioeconomic inequalities in childhood wheezing phenotypes are significantly mediated by maternal smoking during pregnancy and breastfeeding practices.
- Policies aimed at reducing social gradients in these modifiable risk factors may effectively decrease inequalities in childhood wheezing and asthma prevalence.
Abstract:
Wheezing in childhood is socially patterned, but it is unclear what factors explain the social differences.Regression analysis of the UK Millennium Cohort Study, based on 11 141 singleton children who participated at ages 9 months and 3, 5 and 7 years. Relative risk ratios (RRR) for early and persistent/relapsing wheeze were estimated using multinomial regression, according to measures of socioeconomic circumstances. Maternal, antenatal and early-life characteristics were assessed as potential mediators.Children of mothers with no educational qualifications were more likely to have both wheeze types, compared to children of mothers with degree-level qualifications (RRR 1.53, 95% CI 1.26-1.86 for early wheeze; 1.32 95% CI 1.04-1.67 for persistent/relapsing wheeze). Controlling for maternal age, smoking during pregnancy and breastfeeding removed the elevated risk of wheezing. Male sex, maternal age, body mass index, atopy, smoking during pregnancy, preterm birth, breastfeeding, exposure to other children and furry pets were independently associated with wheezing, but the pattern of association varied between wheezing types.In this representative UK cohort, adjustment for maternal smoking during pregnancy and breastfeeding removed the socioeconomic inequalities in common wheezing phenotypes. Policies to reduce the social gradient in these risk factors may reduce inequalities in wheezing and asthma.