Early-Life Wheezing and Childhood Cognition in the ECHO Cohort

Nearly half of children experience wheezing illnesses in the preschool years, which could impair cognitive development.

To investigate whether early-life wheezing illnesses are associated with reduced school-age cognitive function.

Multivariable linear mixed models were run using data from the Environmental influences on Child Health Outcomes (ECHO) Cohort. Participants included children (n = 1524) who were born at ≥ 34 weeks' gestational age or, if gestational age was missing, had a birth weight of ≥ 2500 grams; had a wheeze history documented before 5 years of age; and underwent at least one Wechsler cognitive assessment between ages 6 and 12 years. Wheeze before age 5 years was measured via parental report, and cognitive function was assessed with the Wechsler scales between ages 6 and 12 years.

In unadjusted analysis, wheeze before age 5 years was associated with substantially lower Verbal Comprehension Index (-6.2 [95% CI, -7.9, -4.6]), Perceptual Reasoning Index (-2.7 [-4.2, -1.1]), and Processing Speed Index (-1.8 [-3.3, -0.3]) at ages 6-12 years. However, in multivariate analyses that accounted for cohort and multiple covariates, wheeze was not associated with school-aged cognitive function. Socioeconomic and contextual variables, including annual household income, maternal education, and Childhood Opportunity Index, accounted for much of the association observed in unadjusted analyses.

In a broad U.S. population, early-life childhood wheeze was not associated with school-aged Wechsler cognitive assessment scores. These findings highlight the importance of considering the broader socioeconomic context when interpreting associations between early-life wheezing and school-age neurocognitive development.