title: Childhood wheezing, asthma, allergy, atopy, and lung function: different socioeconomic patterns for different phenotypes.
abstract: Identifying preventable exposures that lead to asthma and associated allergies has proved challenging, partly because of the difficulty in differentiating phenotypes that define homogeneous disease groups. Understanding the socioeconomic patterns of disease phenotypes can help distinguish which exposures are preventable. In the present study, we identified disease phenotypes that are susceptible to socioeconomic variation, and we determined which life-course exposures were associated with these inequalities in a contemporary birth cohort. Participants included children from the Avon Longitudinal Study of Parents and Children, a population-based birth cohort in England, who were born in 1991 and 1992 and attended the clinic at 7-8 years of age (n = 6,378). Disease phenotypes included asthma, atopy, wheezing, altered lung function, and bronchial reactivity phenotypes. Combining atopy with a diagnosis of asthma from a doctor captured the greatest socioeconomic variation, including opposing patterns between phenotype groups: Children with a low socioeconomic position (SEP) had more asthma alone (adjusted multinomial odds ratio = 1.50, 95% confidence interval: 1.21, 1.87) but less atopy alone (adjusted multinomial odds ratio = 0.80, 95% confidence interval: 0.66, 0.98) than did children with high SEP. Adjustment for maternal exposure to tobacco smoke during pregnancy and childhood exposure to tobacco smoke reduced the odds of asthma alone in children with a low SEP. Current inequalities among children who have asthma but not atopy can be prevented by eliminating exposure to tobacco smoke. Other disease phenotypes were not socially patterned or had SEP patterns that were not related to smoke exposure.
authors.forename: Bruna
authors.initials: B
authors.lastname: Galobardes
authors.forename: Raquel
authors.initials: R
authors.lastname: Granell
authors.forename: Jonathan
authors.initials: J
authors.lastname: Sterne
authors.forename: Rachael
authors.initials: R
authors.lastname: Hughes
authors.forename: Cilia
authors.initials: C
authors.lastname: Mejia-Lancheros
authors.forename: George
authors.initials: G
authors.lastname: Davey Smith
authors.forename: John
authors.initials: J
authors.lastname: Henderson
mesh_terms: D001249:Asthma / Q000453:epidemiology* / Q000503:physiopathology; D002648:Child; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000453:epidemiology* / Q000503:physiopathology; D008137:Longitudinal Studies; D008297:Male; D010641:Phenotype; D012129:Respiratory Function Tests; D012135:Respiratory Sounds / Q000503:physiopathology; D012307:Risk Factors; D012923:Social Class
keywords: asthma; atopy; childhood; inequalities; phenotypes; socioeconomic position