University of Oulu

Lewis, K.M., Ruiz, M., Goldblatt, P. et al. Eur J Epidemiol (2017) 32: 797.

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

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Author: Lewis, Kate Marie1; Ruiz, Milagros1; Goldblatt, Peter2;
Organizations: 1Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
2Research Department of Epidemiology and Public Health, UCL Institute of Health Equity, University College London, London, UK
3Department of Epidemiology, Lazio Regional Health System, Rome, Italy
4Center for Global Health, University of Illinois College of Medicine, Chicago, IL, USA
5Institute of Pediatrics, Obstetrics, and Gynecology, National Academy of Medical Sciences of Ukraine, Kiev, Ukraine
6Institut National de la Santé et de la Recherche Médicale (INSERM), UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
7Institut National de la Santé et de la Recherche Médicale (INSERM), UMR 1153, Early Origin of the Child’s Health and Development Team (ORCHAD), Center for Epidemiology and Statistics, Sorbonne Paris Cité, Paris Descartes University, Paris, France
8Pierre Louis Institute of Epidemiology and Public Health (iPLESP), UMR 1136, Epidemiology of Allergic and Respiratory Diseases (EPAR), Paris, France
9ISGlobal, Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
10Universitat Pompeu Fabra (UPF), Barcelona, Spain
11Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Barcelona, Spain
12IB-Salut Menorca Health Area, Balearic Islands, Spain
13Joint Research Unit of Epidemiology and Environmental Health, FISABIO – Universitat Jaume I – Universitat de Vale ́ ncia, Castello ́ n de la Plana, Spain
14Public Health Department of Gipuzkoa, Gipuzkoa, Spain
15BIODONOSTIA Health Research Institute, San Sebastian, Spain
16Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
17Research Centre of Toxic Compounds in the Environment (RECETOX), Faculty of Science, Masaryk University, Brno, Czech Republic
18Institute of Biostatistics and Analyses (IBA), Masaryk University, Brno, Czech Republic
19EPIUnit – Institute of Public Health, University of Porto, Porto, Portugal
20Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
21Department of Epidemiology and Biostatistics, MRC Health Protection Agency (HPE), Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
22Biocenter Oulu, University of Oulu, Oulu, Finland
23Unit of Primary Care, Oulu University Hospital, Oulu, Finland
24Faculty of Medicine, Center for Life Course Health Research, University of Oulu, Oulu, Finland
25Division of Pediatrics, Department of Clinical and Experimental Medicin, Linköping University, Linköping, Sweden
26Department of Medicine and Health, Community Medicine/ General Practice Faculty of Health Sciences, Linköping University, Linköping, Sweden
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.7 MB)
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Language: English
Published: Springer Nature, 2017
Publish Date: 2019-07-30


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.

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Series: European journal of epidemiology
ISSN: 0393-2990
ISSN-E: 1573-7284
ISSN-L: 0393-2990
Volume: 32
Issue: 9
Pages: 797 - 805
DOI: 10.1007/s10654-017-0309-0
Type of Publication: A1 Journal article – refereed
Field of Science: 314 Health sciences
3121 General medicine, internal medicine and other clinical medicine
Funding: All phases of this study were supported by a European Union’s Seventh Framework Programme grant, 278350, as part of The Determinants to Reduce Health Inequity Via Early Childhood, Realising Fair Employment, and Social Protection (DRIVERS) research programme. The Czech ELSPAC Study (CZ-ELSPAC) was supported by the Ministry of Education of the Czech Republic: CETOCOEN plus project (CZ02101/00/00/15_003/0000469) and RECETOX Research Infrastructure (LM2015051). The Northern Finland Birth Cohort (FI-NFBC8586) received financial support from the Academy of Finland; Biocenter, University of Oulu, Finland; the European Commission EUROBLCS, Framework 5 Award QLG1-CT-2000-01643); EU FP7 EurHEALTHAgeing-277849; the Medical Research Council, UK (PrevMetSyn/SALVE); and the MRC Centenary Early Career Award. The Amsterdam Born Children and their Development Study (NLABCD) received funding from the Netherlands Organization for Health Research and Development (ZonMw) Grant (TOP, 40-00812-98-11010). The All Babies in Southeast Sweden Study (SE-ABIS) has received financial support from the Juvenile Diabetes Research Foundation, Swedish Child Diabetes Foundation (Barndiabetesfonden), The Research Council of South-east Sweden (FORSS), Swedish Research Council K2005-72X-11242-11A, and ALF/County Council of Östergötland. The INMA study was funded in part by grants from the European Union (FP7-ENV-2011-282957 and HEALTH.2010.2.4.5-1), Spain (Instituto de Salud Carlos III and The Ministry of Health), the Conselleria de Sanitat of the Generalitat Valenciana, Department of Health of the Basque Government, the Provincial Government of Gipuzkoa, and the Generalitat de Catalunya-CIRIT. Family and Children of Ukraine (UA-FCOU) study was supported by US NIH Fogarty International Center and National Academy of Medical Sciences of Ukraine. KML is funded by a Medical Research Council UK doctoral training studentship.
EU Grant Number: (277849) EURHEALTHAGEING - European ResearcH on DevElopmentAL, BirtH and Genetic Determinants of Ageing
Copyright information: © The Author(s) 2017. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.