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Confounding with familial determinants affects the association between mode of delivery and childhood asthma medication - a national cohort study.

Bråbäck L, Ekéus C, Lowe AJ, Hjern A - Allergy Asthma Clin Immunol (2013)

Bottom Line: An age-matched sibling-pair analysis was also performed to account for shared genetic and environmental risk factors.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.Confounding by familial factors affects the association between mode of delivery and dispensed ICS.

View Article: PubMed Central - HTML - PubMed

Affiliation: Occupational & Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden ; Department of Research and Development, Västernorrland County Council, Sundsvall, Sweden ; Department of Research and Development, Sundsvalls sjukhus, Sundsvall, SE 85186, Sweden.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus

Prevalence of dispensed inhaled corticosteroids at least once in different age groups in relation to mode of delivery.
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Figure 1: Prevalence of dispensed inhaled corticosteroids at least once in different age groups in relation to mode of delivery.

Mentions: Children delivered by non-instrumental vaginal delivery had the lowest rates of asthma medication in all age groups (Figure 1). Children delivered by elective caesarean section had the highest rates in all age groups except the 4-5 year olds while emergency caesarean section and vacuum extraction had a similar rate in all age groups.


Confounding with familial determinants affects the association between mode of delivery and childhood asthma medication - a national cohort study.

Bråbäck L, Ekéus C, Lowe AJ, Hjern A - Allergy Asthma Clin Immunol (2013)

Prevalence of dispensed inhaled corticosteroids at least once in different age groups in relation to mode of delivery.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3643829&req=5

Figure 1: Prevalence of dispensed inhaled corticosteroids at least once in different age groups in relation to mode of delivery.
Mentions: Children delivered by non-instrumental vaginal delivery had the lowest rates of asthma medication in all age groups (Figure 1). Children delivered by elective caesarean section had the highest rates in all age groups except the 4-5 year olds while emergency caesarean section and vacuum extraction had a similar rate in all age groups.

Bottom Line: An age-matched sibling-pair analysis was also performed to account for shared genetic and environmental risk factors.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.Confounding by familial factors affects the association between mode of delivery and dispensed ICS.

View Article: PubMed Central - HTML - PubMed

Affiliation: Occupational & Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden ; Department of Research and Development, Västernorrland County Council, Sundsvall, Sweden ; Department of Research and Development, Sundsvalls sjukhus, Sundsvall, SE 85186, Sweden.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus