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Is the Association of Early Day Care Attendance with Childhood Asthma Explained by Underlying Susceptibility?
Aino K Rantala1,2,3,4,5,6,7, Maria C Magnus1,2,3,4,5,6,7, Øystein Karlstad1
1From the Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.
Insights
Early day care attendance generally lowers asthma risk by age 7. However, children with high genetic susceptibility to asthma may experience increased risk with early day care.
Area of Science:
- Pediatric Allergy and Immunology
- Environmental Epidemiology
- Genetics and Asthma Risk
Background:
- Inconsistent findings exist regarding early day care and asthma development.
- Previous studies may have inadequately controlled for confounding and effect modification.
- This study investigates early day care's impact on asthma risk, considering individual susceptibility.
Purpose of the Study:
- To examine the association between early day care attendance and asthma development by age 7.
- To evaluate the role of underlying asthma susceptibility in modifying this association.
- To provide a nuanced understanding of day care's effect on childhood asthma.
Main Methods:
- Utilized data from 55,404 children in the Norwegian Mother, Father and Child Cohort Study.
- Defined asthma at age 7 based on dispensed medication records.
- Developed a disease risk score (DRS) to quantify asthma susceptibility, incorporating hereditary and non-hereditary factors.
Main Results:
- Early day care (before 18 months) was linked to a reduced risk of asthma by age 7 (RR=0.85).
- The disease risk score (DRS) significantly modified the effect of day care on asthma.
- While most children benefited from reduced asthma risk, a small subgroup with high DRS showed an increased risk (RR up to 2.2).
Conclusions:
- Early day care is associated with decreased asthma risk for the majority of children.
- A subset of children with very high underlying asthma susceptibility may face an elevated asthma risk due to early day care.
- Individualized risk assessment considering genetic predisposition is crucial when evaluating early day care's impact on asthma.
Background:
Previous studies of early day care attendance and asthma development are inconsistent, which may be explained by inadequate control of confounding and effect modification. We examined the effect of early day care on the risk of asthma taking into account the underlying susceptibility to asthma.
Methods:
The study included 55,404 children participating in the Norwegian Mother, Father and Child Cohort Study. Asthma at age 7 was defined by dispensed asthma medications in the Norwegian Prescription Database. We defined a disease risk score (DRS) to account for an underlying susceptibility to asthma including a range of hereditary and nonhereditary predictors of asthma. We assessed confounding and modifying effects of DRS on the association between day care and asthma.
Results:
Day care before 18 months was associated with a lower risk of asthma by age 7 (adjusted risk ratio [RR] = 0.85; 95% confidence interval [CI] = 0.78, 0.92) when compared with home care. DRS modified the estimated effect of day care on asthma risk. Among the 80% of children with DRS between 0.03 and 0.16, day care was associated with a reduced asthma risk (RRs between 0.79 and 0.87), whereas among 0.5% of children with a high DRS (above 0.28), estimated effect of day care on asthma increased gradually (RR for the highest DRS 2.2; 1.0-4.9).
Conclusions:
In our study, among most children, early day care was associated with reduced asthma risk at 7 years, and increased risk in a small group of children with very high underlying susceptibility to asthma.
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