Volume 122, Issue 3 , Pages 500-506.e5, September 2008
Day-care attendance, position in sibship, and early childhood wheezing: A population-based birth cohort study
Background
There are conflicting data on the effect of day-care attendance and position in sibship on the development of wheezing.
Objective
To investigate the relationship between day-care attendance and position in sibship with early childhood wheeze.
Methods
Prospective population-based birth cohort. At age 5 years, we collected information on parentally reported symptoms (n = 922); lung function was ascertained using plethysmography (n = 745) and allergic sensitization by skin testing (n = 815). Participants were assigned into categories according to the age of entry to day-care (0-6, 6-12, >12 mo) and number of older siblings (0, 1, 2, >2).
Results
Current wheeze was reported by 203 participants (22%); 224 (28%) were sensitized. In the multivariate model, sensitization (odds ratio, 2.47; 95% CI, 1.66-3.67), male sex (1.49, 1.01-2.20), maternal asthma (1.72, 1.10-2.68), and maternal smoking during pregnancy (2.15, 1.26-3.66) significantly increased the risk of wheezing. Entering day-care between 6 and 12 or after 12 months of age was significantly and inversely associated with current wheeze (0.25, 0.11-0.60; and 0.65, 0.44-0.98, respectively). Entry into nursery between 6 and 12 months reduced the risk of persistent wheezing (P = .04). We found no association between day-care attendance and lung function. Entering nursery in the first 6 months of life was associated with increased risk of atopy (2.47, 1.23-4.95). Having older siblings was associated only with rhinoconjunctivitis (0.72, 0.54-0.97).
Conclusion
Day-care attendance was associated with a reduced risk of current wheezing in 5-year-old children. The protective effect appeared strongest for children who entered day-care between the ages of 6 and 12 months.
Key words: Day-care, siblings, wheezing, birth cohort
Abbreviations used: MAAS, Manchester Asthma and Allergy Study, OR, Odds ratio, SES, Socioeconomic status, UK, United Kingdom
Supported by Asthma UK grant no. 04/014 and the Moulton Charitable Trust.
Disclosure of potential conflict of interest: A. Simpson receives grant support from the Medical Research Council UK, the Moulton Charitable Trust, Asthma UK, and the Grand Charity. C. S. Murray receives grant support from the Medical Research Council UK, the Moulton Charitable Trust, Asthma UK, the Grand Charity, GlaxoSmithKline, and Pharmaxis. A. Woodcock is a consultant for GlaxoSmithKline, Chiesi Pharmaceuticals, and Schering-Plough and receives grant support from the Medical Research Council UK, the Moulton Charitable Trust, Asthma UK, the Grand Charity, Schering-Plough, GlaxoSmithKline, and Cambridge Antibody. A. Custovic is on the speakers' bureau for GlaxoSmithKline, AstraZeneca, Phadia, and ALK-Abelló; is on the advisory board for GlaxoSmithKline, ALK-Abelló, and UCB Institute of Allergy and receives grant support from the Medical Research Council, the Moulton Charitable Trust, and Asthma UK. The rest of the authors have declared that they have no conflict of interest.
PII: S0091-6749(08)01182-2
doi:10.1016/j.jaci.2008.06.033
© 2008 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
Volume 122, Issue 3 , Pages 500-506.e5, September 2008
