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Parental and life-course influences on symptomatic airflow obstruction

Lok Sze Katrina Li, Marie T. Williams, Kylie N. Johnston, Peter Frith, Elina Hyppönen, Catherine Paquet
ERJ Open Research 2020 6: 00343-2019; DOI: 10.1183/23120541.00343-2019
Lok Sze Katrina Li
1School of Health Sciences, University of South Australia, Adelaide, Australia
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  • For correspondence: katrina.li@unisa.edu.au
Marie T. Williams
1School of Health Sciences, University of South Australia, Adelaide, Australia
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Kylie N. Johnston
1School of Health Sciences, University of South Australia, Adelaide, Australia
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Peter Frith
1School of Health Sciences, University of South Australia, Adelaide, Australia
2College of Medicine and Public Health, Flinders University, Adelaide, Australia
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  • ORCID record for Peter Frith
Elina Hyppönen
1School of Health Sciences, University of South Australia, Adelaide, Australia
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Catherine Paquet
1School of Health Sciences, University of South Australia, Adelaide, Australia
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  • FIGURE 1
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    FIGURE 1

    a) Total association between parental respiratory disease history and airway obstruction and respiratory symptoms. b) Indirect (path a and b) and direct (path c') associations between parental respiratory disease history and airway obstruction and respiratory symptoms through life-course factors.

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  • TABLE 1

    Summary of COPD risk factors operationalised with respect to life period

    COPD risk factorCritical life period and age of cohort members when data were collectedCumulative exposure
    CategoryIndividual factorIn utero/at birthChildhoodAdulthood
    0 years of age7 years of age11 years of age16 years of age23 years of age33 years of age42 years of age
    Smoking exposurePassive smoke exposureSmoking status during pregnancy (4 months)Living with a smokerLiving with smoker at any stageCombined passive smoking exposure (in utero, childhood and adulthood) personal smoking in adulthood
    Personal smoking statusPersistent smoker ever smoker, and never smoker
    SCSC (occupation and classified as: professional/managerial, unskilled nonmanual, skilled manual, unskilled manual)SC of male headSC of male headOwn SCCombined social class at birth, 11 and 42 years (range 0–9), with higher scores indicating lower social class
    AsthmaAsthmaReport of ever having asthma or bronchitisEver asthma in adulthoodChildhood and adulthood reporting of asthma
    OthersLow birth weightBirth weight <2.5 kg
    Preterm birthGestation age <37 weeks
    PneumoniaEver had pneumonia
    Occupation exposureMinimal or potential occupational exposure to dust, gases and fume
    Biomass exposureParaffin or solid fuel as heating source

    SC: social class.

    • TABLE 2

      Descriptive statistics of life-course factors in the study sample

      Cohort member characteristicsTotal (n=6212)No parental respiratory disease history (n=5983)Reported parental respiratory disease history (n=229)p-value#
      Smoking exposure
       Childhood passive smoke exposure4185 (67%)4015 (67%)170 (74%)0.024
       Adulthood passive smoke exposure3470 (56%)3330 (56%)140 (61%)0.101
       Adulthood smoking status0.003
        Never3751 (60%)3620 (61%)131 (57%)
        Ever1330 (21%)1292 (22%)38 (17%)
        Persistent1131 (18%)1071 (18%)60 (26%)
       Cumulative smoking0.002
        0 (never)905 (15%)885 (15%)20 (9%)
        11874 (30%)1802 (30%)72 (31%)
        21702 (27%)1645 (28%)57 (25%)
        31031 (17%)993 (17%)38 (17%)
        4 (persistent exposure)700 (12%)658 (11%)42 (18%)
      SC
       At birth0.001
        SC11216 (20%)1191 (20%)25 (11%)
        SC2619 (10%)604 (10%)15 (7%)
        SC33096 (50%)2962 (50%)134 (59%)
        SC41281 (21%)1226 (20%)55 (24%)
       At 11 years of age<0.001
        SC11570 (25%)1544 (26%)26 (11%)
        SC2670 (11%)650 (11%)20 (9%)
        SC32640 (43%)2550 (43%)90 (39%)
        SC41332 (22%)1239 (21%)93 (41%)
       At 42 years of age0.001
        SC12535 (41%)2459 (41%)76 (33%)
        SC21512 (24%)1465 (25%)47 (21%)
        SC31179 (19%)1127 (19%)52 (22%)
        SC4986 (16%)932 (16%)54 (24%)
       Cumulative SC mean±sd (range 0–9)4.42±2.434.38±2.425.41±2.29<0.001
      Asthma
       Childhood asthma1391 (22%)1328 (22%)63 (28%)0.058
       Adulthood asthma818 (13%)766 (13%)52 (23%)<0.001
       Cumulative asthma0.003
        0 (never)4430 (71%)4290 (72%)140 (61%)
        11361 (22%)1298 (22%)63 (28%)
        2 (persistent)421 (7%)395 (7%)26 (11%)
      Others
       Low birth weight317 (5%)293 (5%)24 (111%)<0.001
       Born preterm¶216 (4%)209 (4%)7 (3%)0.723
       Had pneumonia¶266 (4%)251 (4%)15 (7%)0.084
       Biomass exposure¶776 (13%)742 (12%)34 (15%)0.272
       Occupational exposure1897(31%)1813 (30%)84 (37%)0.040

      SC: social class (SC1: professional/managerial; SC2: unskilled nonmanual; SC3: skilled manual; SC4: unskilled manual). #: calculated by Chi-squared or independent sample t-test as appropriate, significant level set at p<0.1; ¶: based on mean of 10 imputed datasets.

      • TABLE 3

        Models detailing associations between parental respiratory disease history, individual life-course factors and symptomatic airflow obstruction (outcome), by category (smoking, social class, asthma and others)

        Life-course factorsModel 1aModel 1bModel 1cModel 1d
        Smoking
         Parental respiratory disease history1.87 (1.21–2.89)*1.71 (1.09–2.68)*1.69 (1.08–2.64)*1.70 (1.09–2.65)*
         Passive smoke childhood1.46 (1.15–1.85)**1.23 (0.97–1.58)
         Adulthood smoking
          Ever smoker1.79 (1.34–2.38)***1.77 (1.33–2.36)***
          Persistent smoker4.93 (3.88–6.28)***4.81 (3.78–6.10)***
         Cumulative smoke exposure
          0 (never)1.00 (ref.)
          11.03 (0.67–1.59)
          21.14 (0.74–1.76)
          32.72 (1.80–4.10)***
          4 (persistent)5.33 (3.55–8.00)***
         Total indirect effects estimates (se)0.027 (0.014)0.104 (0.047)*0.117 (0.048)*0.123 (0.044)*
        Model 2aModel 2bModel 2cModel 2d
        SC
         Parental respiratory disease history1.88 (1.21–2.92)*1.82 (1.17–2.83)*1.80 (1.16–2.79)*1.76 (1.13–2.73)*
         At birth
          SC11.00 (ref.)
          SC21.15 (0.76–1.75)
          SC31.15 (0.86–1.54)
          SC41.30 (0.93–1.81)
         At 11 years of age
          SC11.00 (ref.)
          SC20.68 (0.43–1.08)
          SC31.13 (0.86–1.47)
          SC41.28 (0.95–1.73)
         At 42 years of age
          SC11.00 (ref.)
          SC21.34 (0.99–1.81)
          SC31.73 (1.30–2.31)***
          SC41.94 (1.44–2.62)***
         Cumulative SC1.09 (1.04–1.14)***
         Total indirect effects estimates (se)0.020 (0.015)0.051 (0.027)0.063 (0.022)**0.088 (0.028)***
        Model 3aModel 3bModel 3cModel 3d
        Asthma
         Parental respiratory disease history1.83 (1.18–2.83)*1.54 (0.96–2.47)1.53 (0.96–2.45)1.62 (1.03–2.55)**
         Childhood asthma2.17 (1.74–2.70)***1.30 (1.02–1.67)**
         Adulthood asthma6.12 (4.89–7.64)***5.59 (4.39–7.11)***
         Cumulative asthma
          0 (never)1.00 (ref.)
          12.53 (1.98–3.24)***
          2 (persistent)7.22 (5.44–9.59)***
         Total indirect effects estimates (se)0.041 (0.024)0.180 (0.052)**0.185 (0.053)***0.150 (0.048)**
        Model 4aModel 4bModel 4cModel 4d
        Others
         Parental respiratory disease history1.88 (1.21–2.91)*1.90 (1.22–2.94)**1.87 (1.20–2.90)*1.85 (1.19–2.87)*
         Low birth weight1.34 (0.87–2.05)
         Pneumonia (childhood)1.79 (1.16–2.77)*1.78 (1.15–2.75)*
         Occupational exposure1.39 (1.11–1.76)*1.39 (1.10–1.75)*
         Total indirect effects estimates (se)0.016 (0.014)0.008 (0.010)0.021 (0.014)0.029 (0.017)

        Data are presented as OR (95% CI) unless otherwise stated. All models were adjusted for sex and recent chest infection (past 3 weeks prior to when spirometry was performed at age 45 years). SC: social class (SC1: professional/managerial; SC2: unskilled nonmanual; SC3: skilled manual; SC4: unskilled manual). *: p<0.05; **: p<0.005; ***: p<0.001.

        • TABLE 4

          Associations between parental respiratory disease history, combined life-course factors and symptomatic airflow obstruction (outcome)

          Model 5aModel 5b
          Parental respiratory disease history1.29 (0.80–2.09)1.34 (0.84–2.14)
          Childhood passive smoke exposure1.18 (0.91–1.52)
          Adulthood smoking
           Ever-smoker1.71 (1.27–2.31)***
           Persistent smoker5.42 (4.19–7.01)***
          SC at 42 years of age
           SC11.00 (ref)
           SC21.20 (0.87–1.67)
           SC31.29 (0.92–1.81)
           SC41.41 (1.00–1.99)
          Asthma
           Childhood1.33 (1.02–1.72)*
           Adulthood6.44 (5.01–8.27)***
          Pneumonia (childhood)1.33 (0.82–2.16)1.13 (0.71–1.79)
          Occupational exposure1.00 (0.76–1.30)1.09 (0.84–1.40)
          Cumulative SC1.03 (0.98–1.08)
          Cumulative smoking exposure
           0 (never)1.00 (ref.)
           10.98 (0.63–1.52)
           21.07 (0.68–1.67)
           32.38 (1.55–3.64)***
           4 (persistent)5.39 (3.51–8.27)***
          Cumulative asthma
           0 (never)1.00 (ref.)
           12.51 (1.95–3.23)***
           2 (persistent)8.13 (5.98–11.07)***
          Total effects estimate (se)0.614 (0.258)**0.603 (0.250)**
          Total indirect effects estimate (se)0.359 (0.082)***0.308 (0.075)***
          Model fit
           AIC57 978.79668 436.130
           BIC58 295.30668 718.968

          Data are presented as OR (95% CI) unless otherwise stated. All models were adjusted for sex and recent chest infection (past 3 weeks prior to when spirometry was performed at age 45 years). SC: social class (SC1: professional/managerial; SC2: unskilled nonmanual; SC3: skilled manual; SC4: unskilled manual); AIC: Akaike information criterion; BIC: Bayesian information criterion. *: p<0.05; **: p<0.005; ***: p<0.001.

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          Parental and life-course influences on symptomatic airflow obstruction
          Lok Sze Katrina Li, Marie T. Williams, Kylie N. Johnston, Peter Frith, Elina Hyppönen, Catherine Paquet
          ERJ Open Research Jan 2020, 6 (1) 00343-2019; DOI: 10.1183/23120541.00343-2019

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          Parental and life-course influences on symptomatic airflow obstruction
          Lok Sze Katrina Li, Marie T. Williams, Kylie N. Johnston, Peter Frith, Elina Hyppönen, Catherine Paquet
          ERJ Open Research Jan 2020, 6 (1) 00343-2019; DOI: 10.1183/23120541.00343-2019
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