Socioeconomic and sociodemographic factors associated with asthma related outcomes in early childhood: the Generation R Study

PLoS One. 2013 Nov 11;8(11):e78266. doi: 10.1371/journal.pone.0078266. eCollection 2013.


Rationale: Few studies have analyzed the association of socioeconomic and sociodemographic factors with asthma related outcomes in early childhood, including Fraction of exhaled Nitric Oxide (FeNO) and airway resistance (Rint). We examined the association of socioeconomic and sociodemographic factors with wheezing, asthma, FeNO and Rint at age 6 years. Additionally, the role of potential mediating factors was studied.

Methods: The study included 6717 children participating in The Generation R Study, a prospective population-based cohort study. Data on socioeconomic and sociodemographic factors, wheezing and asthma were obtained by questionnaires. FeNO and Rint were measured at the research center. Statistical analyses were performed using logistic and linear regression models.

Results: At age 6 years, 9% (456/5084) of the children had wheezing symptoms and 7% (328/4953) had asthma. Children from parents with financial difficulties had an increased risk of wheezing (adjusted Odds Ratio (aOR) = 1.63, 95% Confidence Interval (CI):1.18-2.24). Parental low education, paternal unemployment and child's male sex were associated with asthma, independent of other socioeconomic or sociodemographic factors (aOR = 1.63, 95% CI:1.24-2.15, aOR = 1.85, 95% CI:1.11-3.09, aOR = 1.58, 95% CI:1.24-2.01, respectively). No socioeconomic or gender differences in FeNO were found. The risks of wheezing, asthma, FeNO and Rint measurements differed between ethnic groups (p<0.05). Associations between paternal unemployment, child's sex, ethnicity and asthma related outcomes remained largely unexplained.

Conclusions: This study showed differences between the socioeconomic and sociodemographic correlates of wheezing and asthma compared to the correlates of FeNO and Rint at age 6 years. Several socioeconomic and sociodemographic factors were independently associated with wheezing and asthma. Child's ethnicity was the only factor independently associated with FeNO. We encourage further studies on underlying pathways and public health intervention programs, focusing on reducing socioeconomic or sociodemographic inequalities in asthma.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Twin Study

MeSH terms

  • Adolescent
  • Asthma / economics*
  • Asthma / epidemiology*
  • Asthma / ethnology
  • Asthma / physiopathology
  • Child
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Netherlands / epidemiology
  • Prospective Studies
  • Respiratory Sounds
  • Sex Factors
  • Socioeconomic Factors

Grant support

The general design of the Generation R Study is made possible by financial support from the Erasmus Medical Center, Rotterdam, the Erasmus University Rotterdam, the Netherlands Organization for Health Research and Development (ZonMw), the Netherlands Organisation for Scientific Research (NWO), the Ministry of Health, Welfare and Sport and the Ministry of Youth and Families. E Hafkamp-de Groen received funding by means of the Dutch Lung Foundation (project no. L Duijts received funding by means of a European Respiratory Society/Marie Curie Joint Research Fellowship (MC 1226-2009) under grant agreement RESPIRE, PCOFUND-GA-2008-229571. VWV Jaddoe received additional grants from the Netherlands Organization for Health Research and Development (ZonMw - VIDI). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.