Adverse childhood experiences and asthma: trajectories in a national cohort

Abstract

Objective: Research has linked early adverse childhood experiences (ACEs) with asthma development; however, existing studies have generally relied on parent report of exposure and outcome. We aimed to examine the association of early life ACEs with empirically determined trajectories of childhood asthma risk, using independent register information on both exposures and outcome.

Methods: Based on nationwide registries, we established a study cohort of 466 556 children born in Denmark (1997-2004). We obtained information on ACEs during the first 2 years of life (bereavement, parental chronic somatic and/or mental illness) and childhood asthma diagnosis or medication use from birth through age 10 years from the Danish National Patient and Prescription Registries, respectively. We identified asthma phenotypes using group-based trajectory modelling. We then used multinomial logistic regression to examine the association between early ACEs and asthma phenotypes.

Results: We identified four asthma phenotypes: non-asthmatic, early-onset transient, early-onset persistent and late-onset asthma. Girls with early-onset transient asthma (OR 1.13, 95% CI 1.04 to 1.24), early-onset persistent asthma (1.27, 95% CI 1.08 to 1.48) or late-onset asthma (OR 1.28, 95% CI 1.11 to 1.48) vs no asthma were more likely to have early life ACE exposure compared with girls without ACE exposure. Results were similar for boys who also had experienced early life ACEs with ORs of 1.16 (95% CI 1.08 to 1.25), 1.34 (95% CI 1.20 to 1.51) and 1.11 (95% CI 0.98 to 1.25), respectively.

Conclusion: In a nationwide-population study, we identified three childhood onset asthma phenotypes and found that ACEs early in life were associated with increased odds for each of these asthma phenotypes among both girls and boys.

Keywords: asthma; asthma epidemiology; paediatric asthma.

Figure 1

Flow chart illustrating the identification of the study population.

Figure 2

Phenotypes of asthma identified by group-based trajectories models using register data from a nationwide cohort of children born in Denmark between 1997 and 2004, by sex (girls, n=227 156, boys, n=239 400). Shaded area portray CIs of the trajectories.

Figure 3

Results from sex-stratified multinomial logistic regression analyses between ACEs in early life (0/≥1) and asthma phenotypes. The population includes children born in Denmark between 1997 and 2004. ^aAdjusted for maternal age at delivery (years), parental highest educational level at conception, maternal smoking during pregnancy, maternal place of living at delivery, parity, calendar year of birth and season of birth. ^bIncludes adjustment and imputation by chained equations using a fully conditional method. ACEs, adverse childhood experiences.