Mother’s education and offspring asthma risk in 10 European cohort studies

Kate Marie Lewis, Milagros Ruiz, Peter Goldblatt, Joana Morrison, Daniela Porta, Francesco Forastiere, Daniel Hryhorczuk, Oleksandr Zvinchuk, Marie-Josephe Saurel-Cubizolles, Sandrine Lioret, Isabella Annesi-Maesano, Martine Vrijheid, Maties Torrent, Carmen Iniguez, Isabel Larranaga, Margreet W. Harskamp-van Ginkel, Tanja G. M. Vrijkotte, Jana Klanova, Jan Svancara, Henrique Barross, Sofia Correia, Marjo-Riitta Jarvelin, Anja Taanila, Johnny Ludvigsson, Tomas Faresjo, Michael Marmot, Hynek Pikhart

Highly prevalent and typically beginning in childhood, asthma is a burdensome disease, yet the risk factors for this condition are not clarified. To enhance understanding, this study assessed the cohort-specific and pooled risk of maternal education on asthma in children aged 3-8 across 10 European countries. Data on 47,099 children were obtained from prospective birth cohort studies across 10 European countries. We calculated cohort-specific prevalence difference in asthma outcomes using the relative index of inequality (RII) and slope index of inequality (SII). Results from all countries were pooled using random-effects meta-analysis procedures to obtain mean RII and SII scores at the European level. Final models were adjusted for child sex, smoking during pregnancy, parity, mother's age and ethnicity. The higher the score the greater the magnitude of relative (RII, reference 1) and absolute (SII, reference 0) inequity. The pooled RII estimate for asthma risk across all cohorts was 1.46 (95% CI 1.26, 1.71) and the pooled SII estimate was 1.90 (95% CI 0.26, 3.54). Of the countries examined, France, the United Kingdom and the Netherlands had the highest prevalence's of childhood asthma and the largest inequity in asthma risk. Smaller inverse associations were noted for all other countries except Italy, which presented contradictory scores, but with small effect sizes. Tests for heterogeneity yielded significant results for SII scores. Overall, offspring of mothers with a low level of education had an increased relative and absolute risk of asthma compared to offspring of high-educated mothers.