Mothers, places and risk of hospitalization for childhood asthma: a nationwide study from Sweden: epidemiology of allergic disease.
Objective: This study examines whether neighbourhood deprivation increases the risk of hospitalization for childhood asthma, after accounting for individual-level maternal socio-demographic characteristics.
Methods: An open cohort of all singleton children aged 2-11 years was followed between January 1, 1995 and December 31, 2006. Childhood residential addresses were geocoded and classified according to the level of neighbourhood deprivation. Data were analysed by multilevel logistic regression, with individual-level characteristics (sex, age, maternal marital status, family income, maternal educational attainment, maternal immigration status, maternal urban/rural status, mobility, maternal asthma history and maternal smoking) at the first level and level of neighbourhood deprivation at the second level.
Results: During the study period, among a total of 866,860 children, 17,682 (2.0%) were hospitalized with childhood asthma. Age-adjusted hospital rates for childhood asthma increased with increasing level of neighbourhood deprivation. In the study population, 1.9% and 2.3% of children in the least and most deprived neighbourhoods, respectively, were affected by childhood asthma. Hospital rates of childhood asthma increased with increasing neighbourhood-level deprivation across all individual-level maternal socio-demographic categories, including marital status, educational attainment, urban/rural status, maternal history of asthma and smoking. The odds ratio (OR) for those living in high-deprivation neighbourhoods vs. those living in low-deprivation neighbourhoods was 1.23 (95% confidence interval, 1.16-1.30). High neighbourhood deprivation remained significantly associated with childhood asthma risk after adjustment for maternal socio-demographic characteristics (OR=1.08, p = 0.016).
Conclusions: This study is the largest so far on neighbourhood influences on childhood asthma. Our results suggest that neighbourhood characteristics affect the risk of hospitalization for childhood asthma independent of maternal socio-demographic characteristics.