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. 2017 Feb;139(2):e20162730.
doi: 10.1542/peds.2016-2730. Epub 2017 Jan 16.

Socioeconomic Status, Smoke Exposure, and Health Outcomes in Young Children With Cystic Fibrosis

Thida Ong  1 , Michael Schechter  2 , Jing Yang  3 , Limin Peng  3 , Julia Emerson  4 , Ronald L Gibson  4 , Wayne Morgan  5 , Margaret Rosenfeld  4 ; EPIC Study Group
Affiliations

Socioeconomic Status, Smoke Exposure, and Health Outcomes in Young Children With Cystic Fibrosis

Thida Ong et al. Pediatrics. 2017 Feb.

Abstract

Background: Lower socioeconomic status (SES) and environmental tobacco smoke (ETS) exposure are both associated with poorer disease outcomes in cystic fibrosis (CF), and children with low SES are disproportionately exposed to ETS. We analyzed a large cohort of young children with CF to distinguish the impact of SES and ETS on clinical outcomes.

Methods: The Early Pseudomonas Infection Control Observational study enrolled Pseudomonas-negative young children with CF <13 years of age. An enrollment survey assessed SES and ETS exposures. Forced expiratory volume in 1 second (FEV1), crackles and wheezes, and weight-for-age percentile were assessed at each clinical encounter over at least 4 years. Repeated measures analyses estimated the association of SES and ETS exposures with longitudinal clinical outcomes, adjusting for confounders.

Results: Of 1797 participants, 1375 were eligible for analysis. Maternal education was high school or less in 28.1%, 26.8% had household income <$40 000, and 43.8% had Medicaid or no insurance. Maternal smoking after birth was present in 24.8%, more prevalent in household with low SES. In separate models, lower SES and ETS exposure were significantly associated with lower FEV1% predicted, presence of crackles or wheezes, and lower weight percentile. In combined models, effect estimates for SES changed minimally after adjustment for ETS exposures, whereas estimates for ETS exposures were attenuated after adjusting for SES.

Conclusions: ETS exposure was disproportionately high in low SES families in this cohort of children with CF. Lower SES and ETS exposure had independent adverse effects on pulmonary and nutritional outcomes. Estimated effect of SES on FEV1 decreased minimally after ETS adjustment, suggesting health disparity risks independent of ETS exposure.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Dr Morgan is a consultant to Genentech in his role as Co-Chair of the Epidemiologic Study of Cystic Fibrosis. Dr Rosenfeld is a consultant to Genentech as a member of the North American Scientific Advisory Group of the Epidemiologic Study of Cystic Fibrosis. The other authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Selection of the study cohort.
FIGURE 2
FIGURE 2
Bar charts for each SES variable: A, maternal education; B, family income; C, state insurance coverage, showing the percentage of participants exposed to ETS (as measured by 4 different questions). HS, high school.
FIGURE 3
FIGURE 3
Estimates and 95% CIs (black dots, solid lines) for the difference in mean FEV1 % predicted from multivariable models, including both SES and ETS exposures, and prespecified clinical characteristics. For comparison, gray dots, dashed lines show estimates and 95% CIs from models evaluating SES and ETS exposures separately (Table 2).
See this image and copyright information in PMC

References

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