Parents' childhood socioeconomic circumstances are associated with their children's asthma outcomes

Abstract

Background: Previous literature documents associations between low socioeconomic status (SES) and poor health outcomes, including asthma. However, this literature has largely focused on the effects of current family circumstances.

Objective: We sought to test an intergenerational hypothesis, that the childhood SES that parents experience will be associated with asthma outcomes in their children, independent of effects of current family SES. Second, we aimed to test whether this association is in part due to difficulties in current parent-child relationships.

Methods: This was an observational study, whereby 150 parents were interviewed about their childhood SES and their children (physician-diagnosed asthma, ages 9-17 years) were interviewed about current family stress. Asthma control was assessed by parent report and child report (primary outcome), and blood was collected from children to measure cytokine production relevant to asthma (secondary outcomes).

Results: To the degree that parents had lower childhood SES, their offspring showed worse asthma outcomes across multiple indicators. This included lower asthma control scores (parent and child report, Ps < .05), and greater stimulated production of T_H2 and T_H1 cytokines by PBMCs (Ps < .05). These associations were independent of current family SES. Mediation analyses were consistent with a scenario wherein parents with low childhood SES had current family relationships that were more stressful, and these difficulties, in turn, related to worse asthma control and greater cytokine production in children.

Conclusions: These results suggest the potential "long reach" of low SES across generations, and the importance of expanding theories of how the social environment can affect childhood asthma to include characteristics of earlier generations.

Keywords: Socioeconomic status; asthma; childhood; family stress.

Figure 1

Children’s asthma control by parents’ childhood SES (cSES). Bars are shown by both child report on the Asthma Control Test, as well as parent report on the Asthma Control Test.

Figure 2

Parents’ childhood SES (cSES) and children’s cytokine production in response to stimulation with PMA/INO (25ng/mL/1ug/mL). Bars are shown for both Th1 and Th2 cytokine responses. Cytokine values are standardized and aggregated into composites.