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Meta-Analysis
. 2025 Jun;13(6):1385-1396.
doi: 10.1016/j.jaip.2025.02.032. Epub 2025 May 1.

Understanding Social Inequalities in Childhood Asthma: Quantifying the Mediating Role of Modifiable Early-Life Risk Factors in Seven European Birth Cohorts

Angela Pinot de Moira  1 , Anne V Aurup  2 , Demetris Avraam  3 , Daniela Zugna  4 , Aksel Karl Georg Jensen  5 , Marieke Welten  6 , Timothy Cadman  7 , Blandine de Lauzon-Guillain  8 , Liesbeth Duijts  6 , Ahmed Elhakeem  9 , Ana Esplugues  10 , Judith Garcia-Aymerich  11 , Gonzalo García-Baquero  12 , Llúcia González Safont  13 , Jennifer R Harris  14 , Carmen Iñiguez  15 , Vincent W V Jaddoe  6 , Rosemary R C McEachan  16 , Johanna L T Nader  17 , Loreto Santa Marina  18 , Morris A Swertz  7 , Muriel Tafflet  8 , Martine Vrijheid  11 , John Wright  16 , Tiffany C Yang  16 , David Taylor-Robinson  19 , Lorenzo Richiardi  4 , Anne-Marie Nybo Andersen  5
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Free article
Meta-Analysis

Understanding Social Inequalities in Childhood Asthma: Quantifying the Mediating Role of Modifiable Early-Life Risk Factors in Seven European Birth Cohorts

Angela Pinot de Moira et al. J Allergy Clin Immunol Pract. 2025 Jun.
Free article

Abstract

Background: Children growing up in disadvantaged socioeconomic circumstances (SECs) have an increased risk of asthma.

Objective: To increase our understanding of the pathways to inequalities in asthma and potential targets for intervention by (1) examining how the social patterning of asthma and its early-life risk factors varies across countries and (2) quantifying the mediation of observed inequalities by early-life risk factors.

Methods: We used data for 107,884 mother-child dyads from 7 European birth cohorts across 6 countries. Maternal education was the primary exposure measure of early-life SECs. The outcome was current asthma in childhood (3-12 years). Inequalities were examined using multivariable regression and random effects meta-analysis. The mediating effects of early-life risk factors (maternal smoking during pregnancy, adverse birth outcomes, and breastfeeding duration) were examined using counterfactual mediation analysis.

Results: In meta-analysis, children of mothers with low/medium versus high education had a 17% (95% confidence interval: 8%-27%, I2 = 21.6%) increased risk of asthma. Cohort-specific risk ratios ranged between 1.07 (0.97-1.18, Danish National Birth Cohort, Denmark) and 1.61 (1.08-2.40, study on the pre- & early postnatal determinants of child health & development, France). The early-life risk factors were similarly socially patterned, but with greater heterogeneity across cohorts (I2 range = 66.2%-95.3%). The mediation analysis suggested that these factors play a relevant role in mediating observed inequalities (proportion mediated range: 0.08-0.72).

Conclusions: There was a consistent tendency for children from disadvantaged SECs to be at greater risk of asthma in the European cohorts examined. Our results suggest that early-life risk factors partially mediate these disparities and, therefore, that public health interventions in the perinatal period may help to address inequalities in asthma.

Keywords: Birth cohort; Childhood asthma; Cross-cohort; Inequalities; Meta-analysis; Socioeconomic.

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