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. 2004 May;59(5):376–380. doi: 10.1136/thx.2003.010363

Relationship between socioeconomic status and asthma: a longitudinal cohort study

R Hancox 1, B Milne 1, D Taylor 1, J Greene 1, J Cowan 1, E Flannery 1, G Herbison 1, C McLachlan 1, R Poulton 1, M Sears 1
PMCID: PMC1747001  PMID: 15115861

Abstract

Background: There is conflicting information about the relationship between asthma and socioeconomic status, with different studies reporting no, positive, or inverse associations. Most of these studies have been cross sectional in design and have relied on subjective markers of asthma such as symptoms of wheeze. Many have been unable to control adequately for potential confounding factors.

Methods: We report a prospective cohort study of approximately 1000 individuals born in Dunedin, New Zealand in 1972–3. This sample has been assessed regularly throughout childhood and into adulthood, with detailed information collected on asthma symptoms, lung function, airway responsiveness, and atopy. The prevalence of these in relation to measures of socioeconomic status were analysed with and without controls for potential confounding influences including parental history of asthma, smoking, breast feeding, and birth order using cross sectional time series models.

Results: No consistent association was found between childhood or adult socioeconomic status and asthma prevalence, lung function, or airway responsiveness at any age. Having asthma made no difference to educational attainment or socioeconomic status by age 26. There were trends to increased atopy in children from higher socioeconomic status families consistent with previous reports.

Conclusions: Socioeconomic status in childhood had no significant impact on the prevalence of asthma in this New Zealand born cohort. Generalisation of these results to other societies should be done with caution, but our results suggest that the previously reported associations may be due to confounding.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson H. R., Butland B. K., Strachan D. P. Trends in prevalence and severity of childhood asthma. BMJ. 1994 Jun 18;308(6944):1600–1604. doi: 10.1136/bmj.308.6944.1600. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Burney P. G., Chinn S., Rona R. J. Has the prevalence of asthma increased in children? Evidence from the national study of health and growth 1973-86. BMJ. 1990 May 19;300(6735):1306–1310. doi: 10.1136/bmj.300.6735.1306. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Burney P., Chinn S. Developing a new questionnaire for measuring the prevalence and distribution of asthma. Chest. 1987 Jun;91(6 Suppl):79S–83S. doi: 10.1378/chest.91.6_supplement.79s. [DOI] [PubMed] [Google Scholar]
  4. Chai H., Farr R. S., Froehlich L. A., Mathison D. A., McLean J. A., Rosenthal R. R., Sheffer A. L., Spector S. L., Townley R. G. Standardization of bronchial inhalation challenge procedures. J Allergy Clin Immunol. 1975 Oct;56(4):323–327. doi: 10.1016/0091-6749(75)90107-4. [DOI] [PubMed] [Google Scholar]
  5. Chen Y., Tang M., Krewski D., Dales R. Relationship between asthma prevalence and income among Canadians. JAMA. 2001 Aug 22;286(8):919–920. [PubMed] [Google Scholar]
  6. Duran-Tauleria E., Rona R. J. Geographical and socioeconomic variation in the prevalence of asthma symptoms in English and Scottish children. Thorax. 1999 Jun;54(6):476–481. doi: 10.1136/thx.54.6.476. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Eachus J., Williams M., Chan P., Smith G. D., Grainge M., Donovan J., Frankel S. Deprivation and cause specific morbidity: evidence from the Somerset and Avon survey of health. BMJ. 1996 Feb 3;312(7026):287–292. doi: 10.1136/bmj.312.7026.287. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Ferris B. G. Epidemiology Standardization Project (American Thoracic Society). Am Rev Respir Dis. 1978 Dec;118(6 Pt 2):1–120. [PubMed] [Google Scholar]
  9. Freedman Steven D., Blanco Paola G., Zaman Munir M., Shea Julie C., Ollero Mario, Hopper Isabel K., Weed Deborah A., Gelrud Andres, Regan Meredith M., Laposata Michael. Association of cystic fibrosis with abnormalities in fatty acid metabolism. N Engl J Med. 2004 Feb 5;350(6):560–569. doi: 10.1056/NEJMoa021218. [DOI] [PubMed] [Google Scholar]
  10. Goodman E. The role of socioeconomic status gradients in explaining differences in US adolescents' health. Am J Public Health. 1999 Oct;89(10):1522–1528. doi: 10.2105/ajph.89.10.1522. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Goren A. I., Hellmann S. Has the prevalence of asthma increased in children? Evidence from a long term study in Israel. J Epidemiol Community Health. 1997 Jun;51(3):227–232. doi: 10.1136/jech.51.3.227. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Halfon N., Newacheck P. W. Childhood asthma and poverty: differential impacts and utilization of health services. Pediatrics. 1993 Jan;91(1):56–61. [PubMed] [Google Scholar]
  13. Hamman R. F., Halil T., Holland W. W. Asthma in schoolchildren. Demographic associations and peak expiratory flow rates compared in children with bronchitis. Br J Prev Soc Med. 1975 Dec;29(4):228–238. doi: 10.1136/jech.29.4.228. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Herrström P., Högstedt B. Allergic diseases, dental health, and socioeconomic situation of Swedish teenagers. Allergy, dental health, and social situation. Scand J Prim Health Care. 1994 Mar;12(1):57–61. doi: 10.3109/02813439408997058. [DOI] [PubMed] [Google Scholar]
  15. Jones D. T., Sears M. R., Holdaway M. D., Hewitt C. J., Flannery E. M., Herbison G. P., Silva P. A. Childhood asthma in New Zealand. Br J Dis Chest. 1987 Oct;81(4):332–340. doi: 10.1016/0007-0971(87)90181-1. [DOI] [PubMed] [Google Scholar]
  16. Kitch B. T., Chew G., Burge H. A., Muilenberg M. L., Weiss S. T., Platts-Mills T. A., O'Connor G., Gold D. R. Socioeconomic predictors of high allergen levels in homes in the greater Boston area. Environ Health Perspect. 2000 Apr;108(4):301–307. doi: 10.1289/ehp.00108301. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Leaderer Brian P., Belanger Kathleen, Triche Elizabeth, Holford Theodore, Gold Diane R., Kim Young, Jankun Thomas, Ren Ping, McSharry Je Jean-ellen, Platts-Mills Thomas A. E. Dust mite, cockroach, cat, and dog allergen concentrations in homes of asthmatic children in the northeastern United States: impact of socioeconomic factors and population density. Environ Health Perspect. 2002 Apr;110(4):419–425. doi: 10.1289/ehp.02110419. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Leeder S. R., Corkhill R. T., Irwig L. M., Holland W. W. Influence of family factors on asthma and wheezing during the first five years of life. Br J Prev Soc Med. 1976 Dec;30(4):213–218. doi: 10.1136/jech.30.4.213. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Lewis S. A., Weiss S. T., Platts-Mills T. A., Syring M., Gold D. R. Association of specific allergen sensitization with socioeconomic factors and allergic disease in a population of Boston women. J Allergy Clin Immunol. 2001 Apr;107(4):615–622. doi: 10.1067/mai.2001.113523. [DOI] [PubMed] [Google Scholar]
  20. Lewis S., Richards D., Bynner J., Butler N., Britton J. Prospective study of risk factors for early and persistent wheezing in childhood. Eur Respir J. 1995 Mar;8(3):349–356. doi: 10.1183/09031936.95.08030349. [DOI] [PubMed] [Google Scholar]
  21. Mielck A., Reitmeir P., Wjst M. Severity of childhood asthma by socioeconomic status. Int J Epidemiol. 1996 Apr;25(2):388–393. doi: 10.1093/ije/25.2.388. [DOI] [PubMed] [Google Scholar]
  22. Mitchell E. A., Stewart A. W., Pattemore P. K., Asher M. I., Harrison A. C., Rea H. H. Socioeconomic status in childhood asthma. Int J Epidemiol. 1989 Dec;18(4):888–890. doi: 10.1093/ije/18.4.888. [DOI] [PubMed] [Google Scholar]
  23. Peat J. K., van den Berg R. H., Green W. F., Mellis C. M., Leeder S. R., Woolcock A. J. Changing prevalence of asthma in Australian children. BMJ. 1994 Jun 18;308(6944):1591–1596. doi: 10.1136/bmj.308.6944.1591. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Peckham C., Butler N. A national study of asthma in childhood. J Epidemiol Community Health. 1978 Jun;32(2):79–85. doi: 10.1136/jech.32.2.79. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Poulton Richie, Caspi Avshalom, Milne Barry J., Thomson W. Murray, Taylor Alan, Sears Malcolm R., Moffitt Terrie E. Association between children's experience of socioeconomic disadvantage and adult health: a life-course study. Lancet. 2002 Nov 23;360(9346):1640–1645. doi: 10.1016/S0140-6736(02)11602-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Poyser M. A., Nelson H., Ehrlich R. I., Bateman E. D., Parnell S., Puterman A., Weinberg E. Socioeconomic deprivation and asthma prevalence and severity in young adolescents. Eur Respir J. 2002 May;19(5):892–898. doi: 10.1183/09031936.02.00238402. [DOI] [PubMed] [Google Scholar]
  27. Robertson C. F., Heycock E., Bishop J., Nolan T., Olinsky A., Phelan P. D. Prevalence of asthma in Melbourne schoolchildren: changes over 26 years. BMJ. 1991 May 11;302(6785):1116–1118. doi: 10.1136/bmj.302.6785.1116. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Rona R. J. Asthma and poverty. Thorax. 2000 Mar;55(3):239–244. doi: 10.1136/thorax.55.3.239. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Rona R. J., Chinn S., Burney P. G. Trends in the prevalence of asthma in Scottish and English primary school children 1982-92. Thorax. 1995 Sep;50(9):992–993. doi: 10.1136/thx.50.9.992. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Sarpong S. B., Hamilton R. G., Eggleston P. A., Adkinson N. F., Jr Socioeconomic status and race as risk factors for cockroach allergen exposure and sensitization in children with asthma. J Allergy Clin Immunol. 1996 Jun;97(6):1393–1401. doi: 10.1016/s0091-6749(96)70209-9. [DOI] [PubMed] [Google Scholar]
  31. Schenker M. B., Samet J. M., Speizer F. E. Risk factors for childhood respiratory disease. The effect of host factors and home environmental exposures. Am Rev Respir Dis. 1983 Dec;128(6):1038–1043. doi: 10.1164/arrd.1983.128.6.1038. [DOI] [PubMed] [Google Scholar]
  32. Sears M. R., Burrows B., Flannery E. M., Herbison G. P., Hewitt C. J., Holdaway M. D. Relation between airway responsiveness and serum IgE in children with asthma and in apparently normal children. N Engl J Med. 1991 Oct 10;325(15):1067–1071. doi: 10.1056/NEJM199110103251504. [DOI] [PubMed] [Google Scholar]
  33. Sears M. R., Herbison G. P., Holdaway M. D., Hewitt C. J., Flannery E. M., Silva P. A. The relative risks of sensitivity to grass pollen, house dust mite and cat dander in the development of childhood asthma. Clin Exp Allergy. 1989 Jul;19(4):419–424. doi: 10.1111/j.1365-2222.1989.tb02408.x. [DOI] [PubMed] [Google Scholar]
  34. Sears M. R., Jones D. T., Holdaway M. D., Hewitt C. J., Flannery E. M., Herbison G. P., Silva P. A. Prevalence of bronchial reactivity to inhaled methacholine in New Zealand children. Thorax. 1986 Apr;41(4):283–289. doi: 10.1136/thx.41.4.283. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Sears M. R., Jones D. T., Silva P. A., Simpson A., Williams S. M. Asthma in seven year old children: a report from the Dunedin Multidisciplinary Child Development Study. N Z Med J. 1982 Aug 11;95(713):533–536. [PubMed] [Google Scholar]
  36. Sears Malcolm R., Greene Justina M., Willan Andrew R., Taylor D. Robin, Flannery Erin M., Cowan Jan O., Herbison G. Peter, Poulton Richie. Long-term relation between breastfeeding and development of atopy and asthma in children and young adults: a longitudinal study. Lancet. 2002 Sep 21;360(9337):901–907. doi: 10.1016/S0140-6736(02)11025-7. [DOI] [PubMed] [Google Scholar]
  37. Sears Malcolm R., Taylor D. Robin, Poulton Richie. Breastfeeding and asthma: appraising the controversy--a rebuttal. Pediatr Pulmonol. 2003 Nov;36(5):366–368. doi: 10.1002/ppul.10374. [DOI] [PubMed] [Google Scholar]
  38. Stewart A. W., Mitchell E. A., Pearce N., Strachan D. P., Weiland S. K., ISAAC Steering Committee. International Study for Asthma and Allergy in Childhood The relationship of per capita gross national product to the prevalence of symptoms of asthma and other atopic diseases in children (ISAAC). Int J Epidemiol. 2001 Feb;30(1):173–179. doi: 10.1093/ije/30.1.173. [DOI] [PubMed] [Google Scholar]
  39. Strachan D. P. Family size, infection and atopy: the first decade of the "hygiene hypothesis". Thorax. 2000 Aug;55 (Suppl 1):S2–10. doi: 10.1136/thorax.55.suppl_1.s2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Strachan D. P. Time trends in asthma and allergy: ten questions, fewer answers. Clin Exp Allergy. 1995 Sep;25(9):791–794. doi: 10.1111/j.1365-2222.1995.tb00019.x. [DOI] [PubMed] [Google Scholar]
  41. Weitzman M., Gortmaker S., Sobol A. Racial, social, and environmental risks for childhood asthma. Am J Dis Child. 1990 Nov;144(11):1189–1194. doi: 10.1001/archpedi.1990.02150350021016. [DOI] [PubMed] [Google Scholar]
  42. von Mutius E., Martinez F. D., Fritzsch C., Nicolai T., Roell G., Thiemann H. H. Prevalence of asthma and atopy in two areas of West and East Germany. Am J Respir Crit Care Med. 1994 Feb;149(2 Pt 1):358–364. doi: 10.1164/ajrccm.149.2.8306030. [DOI] [PubMed] [Google Scholar]

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