Parental Occupation and Risk of Hospitalization for Asthma in Children and Adolescents

Utilize administrative data to assess impact of individual-level and neighborhood-level socioeconomic status on childhood health in a longitudinal study

OBJECTIVES

Our study aims to 1) propose an approach to standardize individual-level and neighborhood-level socioeconomic status (SES) measures from administrative records across three decades, 2) determine the degree of agreement between individual-level and neighborhood-level SES measures, and 3) compare the associations of individual-level and neighborhood-level SES measures and childhood health.

STUDY DESIGN

Retrospective observational study.

METHODS

Our cohort included children born in Utah during 1978-2008. Parental SES indicators including education, occupation, and area household income corresponding to maternal addresses were collected from birth certificates. Spearman rank correlation tests were used to determine the correlation between SES measures. Cox regression models and causal mediation analyses were used to assess the association between three childhood health outcomes-mortality, failure-to-thrive, and asthma- and three SES measures: highest education level and occupational status score of parent(s) and area household income.

RESULTS

819,108 children were included in the final analysis. We observed moderate agreement (r ranges 0.43-0.49) between individual-level SES measures (education and occupation) and weak agreement (r ranges 0.19-0.25) between these measures and neighborhood-level SES measures. Parental education had the strongest association with childhood health. The associations of parental occupation and area household income with childhood health, and their mediating effects on parental education, varied by the severity of health outcomes.

CONCLUSIONS

We introduced an approach to standardize SES measures from administrative records for longitudinal analyses. We confirmed that individual-level and neighborhood-level SES measures are distinct indicators of social standing and validated the importance of the choice of SES measures when analyzing childhood health.

Maternal occupational exposure to asthmogenic during pregnancy and the future risk of asthma in children: A meta-analysis

The association between maternal occupational exposure during pregnancy and the subsequent development of asthma in their children has always been a matter of debate, and the results of cohort studies on this issue have been controversial. The current study is the first systematic review and meta-analysis aimed at evaluating the risk of developing subsequent asthma in children based on maternal occupational exposure during the gestation period. To retrieve eligible studies, an advanced literature search was performed up to August 10, 2023 from the following databases: PubMed, Scopus, and Google Scholars. The title and abstract of related articles were screened; hence, the full texts were reviewed. Data extraction was conducted; hence, the included articles were analyzed to assess the mention association. From a total of 10 cohort studies with a total record of 5372, it was found that there is no significant relationship between occupational exposure to asthmogenic during pregnancy and later asthma in children. The pooled odds ratio of asthmatic children in patients with maternal occupational exposure to asthmogenic during pregnancy was 1.03 (95% confidence interval, 0.97-1.09) I2= 13% p=0.62. It was concluded that there is no significant association between maternal occupational exposure and future asthma in children. However, future large-scale studies are required to support these results.

Association between parental occupational exposure and the risk of asthma in offspring: A meta-analysis and systematic review

BACKGROUND

Previous epidemiological studies have shown inconsistent results regarding the relation between the risk of asthma in offspring and parental occupational exposure. Therefore, we conducted a comprehensive and systematic collection of currently available epidemiological data to quantify the correlation between the 2.

METHODS

Related studies published before March 2023 were identified through searches of the Cochrane Library, Embase, PubMed, and Web of Science databases. The quality of included studies was assessed using the Newcastle-Ottawa Scale, while pooled odds ratios (ORs) with 95% confidence intervals (CIs) were computed using fixed-effect or random-effects models.

RESULTS

This systematic review included 10 cohort studies, with a total of 89,571 parent-child pairs included in the quantitative analysis. The results exhibited a substantial association between parental occupational exposure to allergens (OR = 1.11; 95% CI: 1.00, 1.23; P = .051) and irritants (OR = 1.19; 95% CI: 1.07, 1.32; P = .001) and an increased risk of asthma in offspring. This association was also observed in the analysis of wheezing (OR = 1.22; 95% CI: 1.11, 1.35; P < .001 and OR = 1.19; 95% CI: 1.08, 1.32; P = .001). Subgroup analysis demonstrated that maternal occupational exposure to allergens (OR = 1.07; 95% CI: 1.02, 1.12; P = .008) and irritants (OR = 1.13; 95% CI: 1.05, 1.21; P = .001) significantly increased the risk of childhood asthma. Furthermore, parental postnatal occupational exposure to allergens (OR = 1.26; 95% CI: 1.10, 1.46; P = .001) and irritants (OR = 1.26; 95% CI: 1.06, 1.49; P = .009) had a more pronounced impact on childhood asthma. Higher levels of exposure (OR = 1.26; 95% CI: 1.10, 1.46; P = .001 and OR = 1.30; 95% CI: 1.16, 1.47; P < .001) were recognized as significant risk factors for childhood asthma.

CONCLUSION

Parental occupational exposure to allergens and irritants increases the risk of asthma and wheezing in offspring, with maternal exposure, postnatal exposure, and high-dose exposure being the primary risk factors for childhood asthma.

Association between maternal occupational exposure to cleaning chemicals during pregnancy and childhood wheeze and asthma

Background

Asthma is a leading cause of childhood morbidity in the U.S. and a significant public health concern. The prenatal period is a critical window during which environmental influences, including maternal occupational exposures, can shape child respiratory health. Cleaning chemicals are commonly encountered in occupational settings, yet few studies have examined the potential link between prenatal occupational exposures to cleaning chemicals and risk of childhood wheeze and asthma.

Methods

We evaluated the potential influence of maternal occupational exposure to cleaning chemicals during pregnancy on pediatric asthma and wheeze at child age 4-6 years in 453 mother-child pairs from two longitudinal pregnancy cohorts, TIDES and GAPPS, part of the ECHO prenatal and early childhood pathways to health (ECHO-PATHWAYS) consortium. Maternal occupational exposure to cleaning chemicals was defined based on reported occupation and frequency of occupational use of chemicals during pregnancy. Child current wheeze and asthma outcomes were defined by parental responses to a widely-used, standardized respiratory outcomes questionnaire administered at child age 4-6 years. Multivariable Poisson regression with robust standard errors was used to estimate relative risk (RR) of asthma in models adjusted for confounding. Effect modification by child sex was assessed using product interaction terms.

Results

Overall, 116 mothers (25.6%) reported occupational exposure to cleaning chemicals during pregnancy, 11.7% of children had current wheeze, and 10.2% had current asthma. We did not identify associations between prenatal exposure to cleaning chemicals and current wheeze [RRadjusted 1.03, 95% confidence interval (CI): 0.56, 1.90] or current asthma (RRadjusted 0.89, CI: 0.46, 1.74) in the overall sample. Analyses of effect modification suggested an adverse association among females for current wheeze (RR 1.82, CI: 0.76, 4.37), compared to males (RR 0.68, CI: 0.29, 1.58), though the interaction p-value was >0.05.

Conclusion

We did not observe evidence of associations between maternal prenatal occupational exposure to cleaning chemicals and childhood wheeze or asthma in the multi-site ECHO-PATHWAYS consortium. We leveraged longitudinal U.S. pregnancy cohorts with rich data characterization to expand on limited and mixed literature. Ongoing research is needed to more precisely characterize maternal occupational chemical exposures and impacts on child health in larger studies.

Factors associated with future hospitalization among children with asthma: a systematic review

OBJECTIVE

Asthma is a leading cause of emergency department (ED) visits and hospitalizations in children, though many could be prevented. Our study objective was to identify factors from the published literature that are associated with future hospitalization for asthma beyond 30 days following an initial asthma ED visit.

DATA SOURCES

We searched CINAHL, CENTRAL, MEDLINE, and Embase for all studies examining factors associated with asthma-related hospitalization in children from January 1, 1992 to February 7, 2022.Selecting Studies: All citations were reviewed independently by two reviewers and studies meeting inclusion criteria were assessed for risk of bias. Data on all reported variables were extracted from full text and categorized according to identified themes. Where possible, data were pooled for meta-analysis using random effects models.

RESULTS

Of 2262 studies, 68 met inclusion criteria. We identified 28 risk factors and categorized these into six themes. Factors independently associated with future hospitalization in meta-analysis include: exposure to environmental tobacco smoke (OR = 1.94 95%CI 0.67-5.61), pets exposure (OR = 1.67 95%CI 1.17-2.37), and previous asthma hospitalizations (OR = 3.47 95% CI 2.95-4.07). Additional related factors included previous acute care visits, comorbid health conditions (including atopy), allergen exposure, severe-persistent asthma phenotype, inhaled steroid use prior to ED visit, poor asthma control, higher severity symptoms at ED presentation, warmer season at admission, longer length of stay or ICU admission, and African-American race/ethnicity.

CONCLUSIONS

We identified multiple factors that are consistently associated with future asthma hospitalization in children and could be used to identify those who would benefit from targeted preventative interventions.

The Exposome Approach in Allergies and Lung Diseases: Is It Time to Define a Preconception Exposome?

Emerging research suggests environmental exposures before conception may adversely affect allergies and lung diseases in future generations. Most studies are limited as they have focused on single exposures, not considering that these diseases have a multifactorial origin in which environmental and lifestyle factors are likely to interact. Traditional exposure assessment methods fail to capture the interactions among environmental exposures and their impact on fundamental biological processes, as well as individual and temporal factors. A valid estimation of exposure preconception is difficult since the human reproductive cycle spans decades and the access to germ cells is limited. The exposome is defined as the cumulative measure of external exposures on an organism (external exposome), and the associated biological responses (endogenous exposome) throughout the lifespan, from conception and onwards. An exposome approach implies a targeted or agnostic analysis of the concurrent and temporal multiple exposures, and may, together with recent technological advances, improve the assessment of the environmental contributors to health and disease. This review describes the current knowledge on preconception environmental exposures as related to respiratory health outcomes in offspring. We discuss the usefulness and feasibility of using an exposome approach in this research, advocating for the preconception exposure window to become included in the exposome concept.

Maternal preconception occupational exposure to cleaning products and disinfectants and offspring asthma

BACKGROUND

Emerging research suggests health effects in offspring after parental chemical exposures before conception. Many future mothers are exposed to potent chemicals at work, but potential offspring health effects are hardly investigated.

OBJECTIVE

We sought to investigate childhood asthma in relation to mother's occupational exposure to cleaning products and disinfectants before conception.

METHODS

The multicenter Respiratory Health In Northern Europe/Respiratory Health In Northern Europe, Spain and Australia generation study investigated asthma and wheeze starting at age less than 10 years in 3318 mother-offspring pairs. From an asthma-specific Job-Exposure Matrix and mothers' occupational history, we defined maternal occupational exposure to indoor cleaning agents (cleaning products/detergents and disinfectants) starting before conception, in the 2-year period around conception and pregnancy, or after birth. Never-employed mothers were excluded. Exposed groups include cleaners, health care workers, cooks, and so forth. Associations were analyzed using mixed-effects logistic regression and ordinary logistic regression with clustered robust SEs and adjustment for maternal education.

RESULTS

Maternal occupational exposure to indoor cleaning starting preconception and continuing (n = 610) was associated with offspring's childhood asthma: odds ratio 1.56 (95% CI, 1.05-2.31), childhood asthma with nasal allergies: 1.77 (1.13-2.77), and childhood wheeze and/or asthma: 1.71 (95% CI, 1.19-2.44). Exposure starting around conception and pregnancy (n = 77) was associated with increased childhood wheeze and/or asthma: 2.25 (95% CI, 1.03-4.91). Exposure starting after birth was not associated with asthma outcomes (1.13 [95% CI, 0.71-1.80], 1.15 [95% CI, 0.67-1.97], 1.08 [95% CI, 0.69-1.67]).

CONCLUSIONS

Mother's occupational exposure to indoor cleaning agents starting before conception, or around conception and pregnancy, was associated with more childhood asthma and wheeze in offspring. Considering potential implications for vast numbers of women in childbearing age using cleaning agents, and their children, further research is imperative.

Comparison of childhood asthma incidence in 3 neighbouring cities in southwestern Ontario: a 25-year longitudinal cohort study

BACKGROUND

Air pollution is a known trigger for exacerbations among individuals with asthma, but its role in the development of new-onset asthma is unclear. We compared the rate of new asthma cases in Sarnia, a city with high pollution levels, with the rates in 2 neighbouring regions in southwestern Ontario, Canada.

METHODS

Using a population-based birth cohort design and linked health administrative data, we compared the hazard of incident asthma among children 0 to 10 years of age between those born in Lambton (Sarnia) and those born in Windsor and London-Middlesex, for the period Apr. 1, 1993, to Mar. 31, 2009. We used Cox proportional hazards models to adjust for year of birth and exposure to air pollutants (nitrogen dioxide, sulphur dioxide [SO₂], ozone and small particulate matter [PM_2.5]), as well as maternal, geographic and socioeconomic factors.

RESULTS

Among 114 427 children, the highest incidence of asthma was in Lambton, followed by Windsor and London-Middlesex (30.3, 24.4 and 19.8 per 1000 person-years, respectively; p < 0.001). Relative to Lambton, the hazard of asthma, adjusted for socioeconomic and perinatal factors, was lower in Windsor (hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.67-0.77) and London-Middlesex (HR 0.65, 95% CI 0.61-0.69). Inclusion of air pollutants attenuated this relative difference in both Windsor (HR 0.79, 95% CI 0.62-1.01) and London-Middlesex (HR 0.89, 95% CI 0.64-1.24).

INTERPRETATION

We identified a higher incidence of asthma among children born in Lambton (Sarnia) relative to 2 other regions in southwestern Ontario. Higher levels of air pollution (particularly SO₂ and PM_2.5) in this region, as experienced by children in their first year of life, may be contributory.

Parental occupations and risk for Crohn's disease in children

BACKGROUND AND OBJECTIVES

Lacunae exist on the identity of specific environmental risk factors that associate with Crohn's disease (CD). We hypothesized that indirect exposures acquired via the parents' occupation may confer susceptibility.

METHODS

A case-control study based on children diagnosed with CD (prior to age 20) at a tertiary care gastroenterology clinic in Montreal, Canada was carried out. Population- and hospital-based controls without IBD were selected. Information on occupations held by the parents was acquired from interview. Jobs were coded using the Canadian National Occupational Classification for Statistics. Associations were examined using logistic regression accounting for potential confounders. Odds ratios (OR) and corresponding 95% confidence intervals (CI) were estimated.

RESULTS

A total of 466 cases and 335 controls were studied. The mean (±SD) age of the cases (12.4 ± 3.2) was slightly higher than controls (10.5 ± 4.9). Gender and ethnicity were equally distributed between the groups. Logistic regression analysis suggested that children whose fathers worked as retail salespersons/sales clerks [odds ratio (OR) 3.6, 95% confidence interval (CI) 1.2-11.1], and whose mothers worked as administrative secretaries (OR 3.2, 95% CI 1.6-6.4), were more likely to be at risk for CD. Mothers who worked as either early childhood educators (OR 2.3, 95% CI 0.85-6.2) or as clerks (OR 2.8, 95% CI 0.8-9.9) also appeared to confer risks, but these associations were statistically not significant.

CONCLUSION

Parental occupations related to 'social mixing' that can potentially enhance exposure to infectious agents, appear to confer higher risk for CD in children.

The 'take home' burden of workplace sensitizers: flour contamination in bakers' families

BACKGROUND

Exposure to flour/flour constituents is a leading cause of occupational asthma. Paternal occupational exposure to flour has been associated with increased likelihood of childhood asthma, raising the possibility of para-occupational exposure whereby family members are exposed to sensitizers 'taken home' on contaminated skin/clothing.

OBJECTIVE

To establish whether workplace contamination of skin/clothing with wheat flour allergen (WFA) and fungal α-amylase (FAA) is associated with increased levels of these allergens in bakers' homes.

METHODS

Bakeries in north-east Scotland were invited to participate. Control subjects were recruited from University of Aberdeen staff and students. Exposure assessment was carried out in bakeries, bakers' cars and the homes of bakers and controls using surface wipe and vacuum sampling; samples were analyzed for total protein, FAA and WFA.

RESULTS

164 wipe samples and 49 vacuum samples were collected from 38 bakers (from 5 bakeries) and 10 controls. Compared to non-bakers, bakers had higher median levels of WFA and FAA in house vacuum samples; the difference was statistically significant for WFA/total protein (515.8×10(-6) vs. 163.7×10(-6), p=0.031), FAA/total protein ratios (1.45×10(-6) vs. 0.04×10(-6), p<0.001) and FAA loading (median 1.2 pg/cm(2) vs. 0.1 pg/cm(2), p<0.001) with workplace exposure-home contamination relationships between bakers with higher and lower workplace contamination. We found positive correlations between WFA contamination of the bakers' foreheads and cars (r(s)0.57, p=0.028), foreheads and houses (r(s)0.46, p=0.025), shoes and houses (r(s)0.45, p=0.029); and between FAA contamination of shoes and houses (r(s)0.46, p=0.023), and cars and houses (r(s)0.70, p=0.008). There was no evidence of bakers using work-sourced flour for domestic baking.

CONCLUSIONS

This work demonstrates pathways for 'take home' exposure of occupationally sourced flour. Taken with our previous work, showing that bakers' children are more likely to have asthma, this supports the need for further investigation to establish whether 'take home' of occupationally sourced flour is widespread with health consequences.