Pinot de Moira Angela, Aurup Anne V, Avraam Demetris, Zugna Daniela, Jensen Aksel Karl Georg, Welten Marieke, Cadman Timothy, de Lauzon-Guillain Blandine, Duijts Liesbeth, Elhakeem Ahmed, Esplugues Ana, Garcia-Aymerich Judith, García-Baquero Gonzalo, González Safont Llúcia, Harris Jennifer R, Iñiguez Carmen, Jaddoe Vincent W V, McEachan Rosemary R C, Nader Johanna L T, Santa Marina Loreto, Swertz Morris A, Tafflet Muriel, Vrijheid Martine, Wright John, Yang Tiffany C, Taylor-Robinson David, Richiardi Lorenzo, Nybo Andersen Anne-Marie
School of Public Health, Imperial College London, London, United Kingdom; Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark.
J Allergy Clin Immunol Pract. 2025 Jun;13(6):1385-1396. doi: 10.1016/j.jaip.2025.02.032. Epub 2025 May 1.
Children growing up in disadvantaged socioeconomic circumstances (SECs) have an increased risk of asthma.
To increase our understanding of the pathways to inequalities in asthma and potential targets for intervention by (1) examining how the social patterning of asthma and its early-life risk factors varies across countries and (2) quantifying the mediation of observed inequalities by early-life risk factors.
We used data for 107,884 mother-child dyads from 7 European birth cohorts across 6 countries. Maternal education was the primary exposure measure of early-life SECs. The outcome was current asthma in childhood (3-12 years). Inequalities were examined using multivariable regression and random effects meta-analysis. The mediating effects of early-life risk factors (maternal smoking during pregnancy, adverse birth outcomes, and breastfeeding duration) were examined using counterfactual mediation analysis.
In meta-analysis, children of mothers with low/medium versus high education had a 17% (95% confidence interval: 8%-27%, I = 21.6%) increased risk of asthma. Cohort-specific risk ratios ranged between 1.07 (0.97-1.18, Danish National Birth Cohort, Denmark) and 1.61 (1.08-2.40, study on the pre- & early postnatal determinants of child health & development, France). The early-life risk factors were similarly socially patterned, but with greater heterogeneity across cohorts (I range = 66.2%-95.3%). The mediation analysis suggested that these factors play a relevant role in mediating observed inequalities (proportion mediated range: 0.08-0.72).
There was a consistent tendency for children from disadvantaged SECs to be at greater risk of asthma in the European cohorts examined. Our results suggest that early-life risk factors partially mediate these disparities and, therefore, that public health interventions in the perinatal period may help to address inequalities in asthma.
在社会经济条件不利（SEC）环境中成长的儿童患哮喘的风险增加。
通过（1）研究哮喘的社会模式及其早期生活危险因素在不同国家的差异，以及（2）量化早期生活危险因素对观察到的不平等的中介作用，加深我们对哮喘不平等途径和潜在干预目标的理解。
我们使用了来自6个国家7个欧洲出生队列的107,884对母婴的数据。母亲教育程度是早期生活社会经济条件的主要暴露指标。结局是儿童期（3至12岁）的当前哮喘状况。使用多变量回归和随机效应荟萃分析来研究不平等情况。使用反事实中介分析来研究早期生活危险因素（孕期母亲吸烟、不良出生结局和母乳喂养持续时间）的中介作用。
在荟萃分析中，母亲教育程度低/中等与高的儿童相比，患哮喘的风险增加了17%（95%置信区间：8%-27%，I² = 21.6%）。特定队列的风险比在1.07（0.97 - 1.18，丹麦国家出生队列，丹麦）和1.61（1.08 - 2.40，儿童健康与发育的产前和产后早期决定因素研究，法国）之间。早期生活危险因素同样存在社会模式差异，但各队列之间的异质性更大（I²范围 = 66.2% - 95.3%）。中介分析表明，这些因素在介导观察到的不平等方面发挥了相关作用（中介比例范围：0.08 - 0.72）。
在所研究的欧洲队列中，来自社会经济条件不利的儿童患哮喘的风险始终较高。我们的结果表明，早期生活危险因素部分介导了这些差异，因此围产期的公共卫生干预措施可能有助于解决哮喘方面的不平等问题。
