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Social inequalities in wheezing in children: findings from the UK Millennium Cohort Study

David C. Taylor-Robinson, Anna Pearce, Margaret Whitehead, Rosalind Smyth, Catherine Law
European Respiratory Journal 2016 47: 818-828; DOI: 10.1183/13993003.01117-2015
David C. Taylor-Robinson
1Dept of Public Health and Policy, University of Liverpool, Liverpool, UK
2UCL Institute of Child Health, London, UK
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  • For correspondence: dctr@liv.ac.uk
Anna Pearce
2UCL Institute of Child Health, London, UK
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Margaret Whitehead
1Dept of Public Health and Policy, University of Liverpool, Liverpool, UK
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Rosalind Smyth
2UCL Institute of Child Health, London, UK
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Catherine Law
2UCL Institute of Child Health, London, UK
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  • FIGURE 1
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    FIGURE 1

    The four stages of the analysis to test mediators of the association between socioeconomic circumstances (SECs) (parental education) and wheezing. a) Estimate unadjusted risk ratio by SECs, also adjusted for demographic factors, e.g. sex and ethnicity; b) explore association between SECs and hypothetical mediators; c) explore association between hypothetical mediators and wheezing; d) enter hypothetical mediators into model; mediation taken to be a reduction in relative risk ratio.

  • FIGURE 2
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    FIGURE 2

    Relative risk ratios (RRRs) for wheezing phenotypes comparing the lowest maternal education group to the highest in sequentially adjusted models. The final adjusted model includes maternal education + sex + ethnicity + maternal age at birth of child + maternal atopy + smoking in pregnancy + low birthweight (LBW) + preterm birth + Caesarean section + breastfeeding + postnatal environment (environmental tobacco smoke, “grime”, damp, pets, siblings and childcare). BMI: body mass index.

  • FIGURE 3
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    FIGURE 3

    Fully adjusted associations between covariates and wheezing phenotypes. GCSE: General Certificate of Secondary Education; BMI: body mass index; ETS: environmental tobacco smoke; RRR: relative risk ratio.

Tables

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  • TABLE 1

    Characteristics of the total study population, by maternal qualifications

    TotalDegree plusDiplomaA-levelsGCSE grades A–CGCSE grades D–GNonep-value#
    Subjects n (%)11 141 (100)1088 (17.8)1165 (9.4)1165 (9.8)3861 (36.1)1145 (11.2)1722 (15.7)
    Wheeze phenotype
     Never66.069.869.371.765.263.359.7<0.001
     Early remitting17.115.714.213.117.619.619.9
     Persistent/relapsing12.011.511.611.012.112.912.9
     Transient/intermittent4.93.04.84.25.14.37.5
    Female49.149.947.349.848.448.648.60.95
    Child's ethnicity
     White88.088.990.589.792.291.472.5<0.001
     Mixed3.03.72.82.72.62.73.7
     Indian1.72.41.42.40.91.22.7
     Pakistani and Bangladeshi3.81.21.23.02.32.613.1
     Black or black British2.52.53.41.31.61.95.3
     Other1.01.30.70.90.50.22.7
    Maternal age years
     14–197.500.53.98.016.714.8<0.001
     20–2416.72.89.215.119.125.926.0
     25–2928.625.433.730.628.631.025.9
     30–3430.342.737.232.629.318.821.2
     35–3914.825.617.514.713.27.110.3
     ≥402.13.51.93.11.80.61.8
    Maternal atopy
     None73.069.470.669.368.671.670.40.18
     Asthma or eczema23.421.425.021.624.623.922.4
     Asthma and eczema6.55.95.47.46.57.26.3
    Maternal BMI
     Underweight5.53.13.03.45.38.49.9<0.001
     Normal range65.775.568.066.763.561.759.7
     Overweight20.115.520.620.521.319.522.5
     Obese6.35.05.96.37.37.25.4
     Morbidly obese2.40.92.63.02.63.22.5
    Maternal smoking
     Never65.287.877.676.060.347.748.8<0.001
     Smoked before pregnancy14.79.414.614.218.417.210.5
     Smoked during pregnancy20.22.87.89.821.235.040.7
    Low birthweight6.23.65.35.36.26.410.0<0.001
    Caesarean section20.524.824.119.120.118.416.9<0.001
    Preterm <37 weeks gestation5.84.75.43.96.55.37.10.008
    Breastfeeding
     Never31.57.118.619.735.847.352.8<0.001
     ≤1 week12.18.113.011.012.616.512.1
     1–6 weeks13.110.013.914.015.413.210.7
     6 weeks–6 months19.826.924.924.919.113.211.7
     ≥6 months23.647.929.730.517.09.812.7
    Exposure to smoke in same room13.12.94.46.813.223.026.2<0.001
    Damp exposure13.59.89.711.413.016.020.6<0.001
    “Grime” in the environment21.120.818.919.320.220.626.30.004
    Furry pets37.529.838.533.041.542.035.9<0.001
    Siblings in household n
     149.544.645.141.545.831.642.2
     2/351.147.251.951.353.148.651.8<0.001
     ≥46.93.33.33.86.26.417.2
    Childcare
     None68.249.059.160.570.976.887.9<0.001
     Informal18.014.621.622.520.618.210.9
     Formal13.836.419.217.08.55.01.2
    • Data are presented as %, unless otherwise stated. All percentages are adjusted for sampling design and attrition. Item missingness: ethnicity 23, maternal age 7, maternal atopy 17, maternal body mass index (BMI) 657, maternal smoking 36, preterm birth 155, Caesarean section 9, environmental tobacco smoke exposure 1, damp exposure 16, grime exposure 103, furry pet exposure 1, childcare type 42. GCSE: General Certificate of Secondary Education. #: Chi-squared.

  • TABLE 2

    Prevalence of wheeze patterns by covariates and univariate relative risk ratios (RRRs) for wheeze patterns for each covariate

    NeverEarly remittingPersistent/relapsing
     %RRR (95% CI)%RRR (95% CI)%RRR (95% CI)
    Total6617.112.0
    Maternal qualifications
     Degree plus69.8115.71.00 (1.00–1.00)11.51.00 (1.00–1.00)
     Diploma69.3114.20.91 (0.72–1.15)11.61.02 (0.77–1.35)
     A-levels71.7113.10.81 (0.66–1.00)110.93 (0.72–1.20)
     GCSE grades A–C65.2117.61.20 (1.02–1.41)12.11.12 (0.92–1.37)
     GCSE grades D–G63.3119.61.37 (1.10–1.71)12.91.24 (0.94–1.63)
     None59.7119.91.48 (1.22–1.80)12.91.31 (1.04–1.65)
    Demographic factors
     Male62.9117.61.00 (1.00–1.00)14.21.00 (1.00–1.00)
     Female69.6116.40.84 (0.75–0.94)9.70.61 (0.53–0.71)
    Ethnicity
     White66.1117.11.00 (1.00–1.00)121.00 (1.00–1.00)
     Mixed63.3118.71.14 (0.80–1.63)11.91.03 (0.72–1.49)
     Indian69.4112.40.69 (0.45–1.06)13.11.04 (0.62–1.73)
     Pakistani and Bangladeshi66.6114.40.84 (0.68–1.03)12.81.06 (0.79–1.41)
     Black or black British62.9121.11.30 (0.92–1.84)10.50.92 (0.61–1.38)
     Other78190.45 (0.28–0.72)8.60.60 (0.32–1.14)
    Maternal age years
     14–1960.7122.91.82 (1.40–2.37)10.70.90 (0.65–1.25)
     20–2463.2119.41.48 (1.21–1.81)12.10.98 (0.77–1.25)
     25–2966.1117.11.25 (1.03–1.50)11.80.91 (0.74–1.13)
     30–3468.6115.21.07 (0.90–1.28)11.90.89 (0.74–1.07)
     35–3967.9114.11.00 (1.00–1.00)13.31.00 (1.00–1.00)
     ≥4062.5120.71.60 (1.12–2.28)10.90.89 (0.57–1.41)
    Maternal atopy
     No risk69.5115.61.00 (1.00–1.00)10.11.00 (1.00–1.00)
     Asthma or eczema/hayfever59.7119.71.47 (1.28–1.67)15.41.76 (1.53–2.03)
     Asthma and eczema/hayfever52.9121.91.84 (1.46–2.33)19.82.57 (2.03–3.25)
    Maternal BMI
     Underweight65119.91.26 (0.95–1.67)11.91.10 (0.79–1.52)
     Normal range67.4116.41.00 (1.00–1.00)11.21.00 (1.00–1.00)
     Overweight63.9117.51.13 (0.97–1.31)13.31.25 (1.05–1.48)
     Obese63.6118.41.19 (0.97–1.47)14.61.38 (1.06–1.80)
     Morbidly obese57.6122.21.58 (1.10–2.29)15.11.57 (1.01–2.45)
    Maternal smoking
     Never69.4115.11.00 (1.00–1.00)11.21.00 (1.00–1.00)
     Smoked before pregnancy62.7118.61.36 (1.16–1.61)12.81.26 (1.06–1.50)
     Smoked during pregnancy58.3122.21.75 (1.51–2.03)13.61.44 (1.23–1.69)
    Cigarettes smoked during  pregnancy cigarettes·day-1
     068.2115.71.00 (1.00–1.00)11.51.00 (1.00–1.00)
     1–961.5121.11.49 (1.23–1.80)11.81.13 (0.91–1.41)
     10–1957.9121.71.63 (1.33–1.99)14.71.50 (1.17–1.93)
     ≥2054.5121.81.74 (1.24–2.42)16.31.77 (1.26–2.48)
    Perinatal factors
     Low birthweight#59.2119.51.30 (1.03–1.65)16.41.58 (1.18–2.10)
     Caesarean section#63.6117.31.08 (0.94–1.25)141.29 (1.08–1.53)
     Preterm <37 weeks gestation#54.2122.31.64 (1.29–2.09)16.91.77 (1.34–2.35)
    Breastfeeding
     Never61.8119.71.00 (1.00–1.00)13.21.00 (1.00–1.00)
     ≤1 week64.5118.20.88 (0.73–1.08)12.30.89 (0.72–1.11)
     1–6 weeks66.9116.50.88 (0.73–1.07)11.30.97 (0.78–1.20)
     6 weeks–6 months71113.80.71 (0.60–0.84)11.30.72 (0.59–0.87)
    Postnatal exposures
     Environmental tobacco smoke#62.3119.51.26 (1.07–1.48)131.17 (0.96–1.44)
     Damp#62.6119.11.22 (1.02–1.46)12.51.12 (0.93–1.35)
     Grime#63.3118.51.19 (1.03–1.37)12.81.15 (0.99–1.33)
     Pets#66.3116.90.99 (0.89–1.11)11.30.90 (0.79–1.04)
     Siblings in household n
      166.5116.41.00 (1.00–1.00)11.91.00 (1.00–1.00)
      2/365.8117.91.10 (0.98–1.24)11.81.00 (0.89–1.12)
      ≥466.5113.90.85 (0.66–1.09)14.41.21 (0.93–1.56)
     Childcare
      No65.8116.51.00 (1.00–1.00)5.31.00 (1.00–1.00)
      Informal66.3117.71.06 (0.91–1.24)4.40.94 (0.79–1.12)
      Formal67.6118.31.08 (0.93–1.24)3.50.84 (0.68–1.04)
    • Data are presented as % or RRR (95% CI). n=11 141. GCSE: General Certificate of Secondary Education; BMI: body mass index. #: reference group for binary variables not shown; reference not low birthweight/Caesarean section/preterm birth.

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    • D.C. Taylor-Robinson
    • A. Pearce
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Social inequalities in wheezing in children: findings from the UK Millennium Cohort Study
David C. Taylor-Robinson, Anna Pearce, Margaret Whitehead, Rosalind Smyth, Catherine Law
European Respiratory Journal Mar 2016, 47 (3) 818-828; DOI: 10.1183/13993003.01117-2015

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Social inequalities in wheezing in children: findings from the UK Millennium Cohort Study
David C. Taylor-Robinson, Anna Pearce, Margaret Whitehead, Rosalind Smyth, Catherine Law
European Respiratory Journal Mar 2016, 47 (3) 818-828; DOI: 10.1183/13993003.01117-2015
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