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Confounding with familial determinants affects the association between mode of delivery and childhood asthma medication: a national cohort study
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Department of Research and Development, Västernorrland County Council and Sundsvalls sjukhus, Sundsvall.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Murdoch Childrens Research Institute and Centre for MEGA Epidemiology , School of Population Health, The University of Melbourne, Melbourne, Australia.
2013 (English)In: Allergy, Asthma & Clinical Immunology, ISSN 1710-1484, E-ISSN 1710-1492, Vol. 9, no 1, 14- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Mode of delivery may affect the risk of asthma but the findings have not been consistent and factors shared by siblings may confound the associations in previous studies. METHODS: The association between mode of delivery and dispensed inhaled corticosteroid (ICS) (a marker of asthma) was examined in a register based national cohort (n=199 837). A cohort analysis of all first born children aged 2-5 and 6-9 years was performed. An age-matched sibling-pair analysis was also performed to account for shared genetic and environmental risk factors. RESULTS: Analyses of first-borns demonstrated that elective caesarean section was associated with an increased risk of dispensed ICS in both 2-5 (adjusted odds ratio (aOR)=1.19, 95% confidence interval (CI) 1.09-1.29) and 6-9 (aOR=1.21, 1.09-1.34) age groups. In the sibling-pair analysis, the increased risk associated with elective caesarean section was confirmed in 2-5 year olds (aOR=1.22, 1.05-1.43) but not in 6-9 year olds (aOR=1.06, 0.78-1.44). Emergency caesarean section and vacuum extraction had some association with dispensed ICS in the analyses of first-borns but these associations were not confirmed in the sibling-pair analyses. CONCLUSIONS: Confounding by familial factors affects the association between mode of delivery and dispensed ICS. Despite this confounding, there was some evidence that elective caesarean section contributed to a modestly increased risk of dispensed ICS but only up to five years of age.

Place, publisher, year, edition, pages
BioMed Central, 2013. Vol. 9, no 1, 14- p.
Keyword [en]
asthma, caesarean section, child, epidemiology, inhaled corticosteroids, sib pair analysis
National Category
Environmental Health and Occupational Health Immunology in the medical area
Identifiers
URN: urn:nbn:se:umu:diva-85028DOI: 10.1186/1710-1492-9-14ISI: 000332406200001PubMedID: 23590822OAI: oai:DiVA.org:umu-85028DiVA: diva2:691082
Available from: 2014-01-27 Created: 2014-01-27 Last updated: 2017-12-06Bibliographically approved

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