International Journal of Epidemiology, Vol 28, 882-887, Copyright © 1999 by International Epidemiological Association
W Nystad, A Skrondal and P Magnus
OBJECTIVE: Our objective was to use a causal model for childhood asthma to
determine whether the effect of day care attendance on asthma was mediated
by recurrent respiratory tract infections. DESIGN: A cross- sectional
survey among 1447 children aged 6-16 years in Oslo. Their parents completed
written questionnaires. A recursive logit model was used to estimate direct
effects in terms of adjusted odds ratios (aOR). RESULTS: Year of birth,
number of siblings and length of maternal education were significantly
associated with day care attendance. Attendance at day care increased the
risk of early infections, aOR = 1.8 (1.3-2.5), and infections were
associated with asthma, aOR = 4.9 (3.4-7.3). The crude association between
day care and asthma was cOR = 1.5 (1.0-2.2), whereas the estimated direct
effect was small and nonsignificant, aOR = 1.2 (0.8-1.9). The results may
be influenced by overreporting of infections among parents of children with
asthma. CONCLUSIONS: Our results suggest that children who attend day care
have an increased risk of asthma with early infections as a mediator of
risk.
ARTICLES
Day care attendance, recurrent respiratory tract infections and asthma
Section of Epidemiology, Department of Population Health Sciences, National Institute of Public Health, Oslo, Norway. wenche.nystad@folkehelsa.no
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