Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden.
Department of Pediatric Research, Faculty of Medicine, University of Oslo, Oslo, Norway.
Inflamm Bowel Dis. 2024 Oct 3;30(10):1801-1811. doi: 10.1093/ibd/izad220.
Ecological observations suggest a negative relationship between childhood socioeconomic status (SES) and inflammatory bowel disease (IBD) risk. Individual-level analyses have been inconsistent and mostly lacked refined assessments of SES. We aimed to comprehensively study the association between early-life SES and later IBD.
This study included 117 493 participants from the Norwegian Mother, Father and Child cohort and Swedish All Babies in Southeast Sweden cohorts. Participants were followed from birth (1997-2009) through 2021. IBD was identified through national patient registers. Questionnaire and register data were used to define parental educational level, employment, and household income level. Cox regression estimated adjusted hazard ratios (aHRs), accounting for other SES exposures and covariates (eg, parental IBD). Cohort-specific estimates were pooled using a random-effects model.
During 2 024 299 person-years of follow-up, 451 participants were diagnosed with IBD (All Babies in Southeast Sweden cohort, n = 113 and Norwegian Mother, Father and Child cohort, n = 338). Early-life maternal, but not paternal, educational level was associated with later IBD (low vs high educational level; pooled aHR, 1.81; 95% confidence interval [CI], 1.16-2.82; and pooled aHR, 1.20; 95% CI, 0.80-1.80; respectively). Having a nonworking mother or father was not significantly associated with IBD (pooled aHR, 0.69; 95% CI, 0.47-1.02; pooled aHR, 0.79; 95% CI, 0.45-1.37). High vs low household income level yielded a pooled aHR of 1.33 (95% CI, 0.94-1.89). Overall, results were largely consistent across cohorts.
In this prospective Scandinavian cohort study, low maternal educational level was, independent of other SES and covariates, significantly associated with later IBD in her child. Further research is needed to elucidate factors that may mediate this relationship.
生态学观察表明，儿童社会经济地位（SES）与炎症性肠病（IBD）风险之间呈负相关。个体水平的分析结果不一致，且大多缺乏对 SES 的精细化评估。本研究旨在全面研究儿童早期 SES 与日后 IBD 之间的关联。
本研究纳入了挪威母亲、父亲和孩子队列以及瑞典东南瑞典所有婴儿队列中的 117493 名参与者。参与者自 1997 年至 2009 年出生开始随访，随访至 2021 年。通过国家患者登记册确定 IBD 病例。问卷调查和登记数据用于定义父母的教育程度、就业状况和家庭收入水平。使用 Cox 回归估计校正后的危险比（aHR），同时考虑了其他 SES 暴露因素和协变量（例如，父母的 IBD 病史）。使用随机效应模型汇总队列特异性估计值。
在 2024299 人年的随访期间，共有 451 名参与者被诊断患有 IBD（所有婴儿在东南瑞典队列中为 113 例，在挪威母亲、父亲和孩子队列中为 338 例）。儿童早期母亲的教育水平与日后 IBD 相关（低 vs 高教育水平；汇总 aHR，1.81；95%置信区间 [CI]，1.16-2.82；汇总 aHR，1.20；95% CI，0.80-1.80），而父亲的教育水平则没有显著关联（汇总 aHR，0.69；95% CI，0.47-1.02；汇总 aHR，0.79；95% CI，0.45-1.37）。母亲或父亲不工作与 IBD 也没有显著关联（汇总 aHR，0.69；95% CI，0.47-1.02；汇总 aHR，0.79；95% CI，0.45-1.37）。高 vs 低家庭收入水平的汇总 aHR 为 1.33（95% CI，0.94-1.89）。总体而言，研究结果在各队列间基本一致。
在这项前瞻性斯堪的纳维亚队列研究中，母亲教育程度较低与日后子女患 IBD 显著相关，且独立于其他 SES 和协变量。还需要进一步的研究来阐明可能介导这种关系的因素。
