Mother’s burden, child’s breath: untangling the roots of asthma inequality
A sprawling Swedish register-based cohort study, drawing on data from over 1.2 million children born between 2006 and 2018, has systematically disentangled how a mother’s socioeconomic position (SEP) shapes her child’s risk of asthma. Using maternal education as a proxy for SEP, the researchers employed counterfactual mediation analysis to quantify the role of two modifiable pathways: maternal obesity and smoking during pregnancy (SDP). They found that children born to mothers with lower educational attainment faced a 15% higher odds of asthma by age three (OR 1.15, 95% CI 1.13–1.16) and a 9% higher odds by age six. The critical finding, however, lies in what drives this disparity.
Obesity and elevated BMI accounted for 20% to 30% of the excess risk, while smoking during pregnancy explained an additional 15% to 20%. These figures represent not merely associations, but the proportion of the socioeconomic inequality in childhood asthma that could, in principle, be eliminated if these risk factors were removed from the causal pathway. The study’s methodological strength lies in its scale and its ability to separate mediation from mediated interaction, offering a granular view of how these exposures combine and compound across SEP strata.
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