Social inequalities in childhood asthma: the role of early-life conditions

Published online May 1, 2025

Asthma is the most common long-term condition of childhood and can significantly affect the quality of life of both the child and their family. While its causes are complex and not fully understood, early-life conditions are thought to play a key role in shaping a child’s risk. In high-income countries, children from disadvantaged socioeconomic circumstances, such as those with lower family income or parental education, are more likely to develop asthma. However, the extent of this inequality varies between countries. Understanding which early-life factors contribute to these inequalities could help identify ways to reduce them.

In a recent issue of The Journal of Allergy and Clinical Immunology: In Practice, Pinot de Moira et al. use data from up to 107,884 mother-child pairs across seven European birth cohorts in the EU Child Cohort Network to examine how socioeconomic circumstances during pregnancy affect a child’s risk of having asthma at around age 7 and how this relationship varies across six countries. Importantly, they also investigate whether early-life experiences such as maternal smoking during pregnancy, low birth weight, preterm birth, caesarean delivery, and breastfeeding duration help explain why asthma is more common in children from disadvantaged socioeconomic circumstances. The authors do this by using statistical methods to estimate how much of the increased risk is explained by these early-life factors and how much might be due to other pathways.

The authors observe a consistent tendency towards higher risk of asthma among children from disadvantaged socioeconomic circumstances, with greatest inequalities seen in the French and British birth cohorts and lowest in the Danish cohort. They also find clear social patterning of the early-life factors. Their analysis suggests that these early-life factors play a consistent role across countries in driving observed inequalities, mediating between 8% and 72% of the effect of socioeconomic circumstances on childhood asthma. This highlights the potential for public health actions in the perinatal period that help mothers to cease smoking, improve birth outcomes, and support breastfeeding to help address inequalities in childhood asthma.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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