Childhood Asthma and Parental Antidepressant Use in a Nationwide Danish Cohort

Figures & data

Figure 1 Flowchart of study inclusion and exclusion criteria in a nationwide cohort of childhood asthma.

Table 1 Demographics Characteristics of the Children with Actively Treated Asthma, of Their Families, and of the Control Families in a Nationwide Danish Cohort

	Cases (N = 28,595)	Controls (N = 28,595) ^a	P-value
Child Age (years)	8 (4, 13)	8 (3, 14)	0.4
Male Child	16,920 (59%)	16,917 (59%)	>0.9
Maternal Age (years)	40 (35, 44)	40 (35, 44)	0.7
Paternal Age (years)	42 (37, 47)	42 (36, 47)	0.092
Antidepressant Use	4823 (17%)	3912 (14%)	<0.001
Maternal	3426 (12%)	2647 (9.3%)	<0.001
Paternal	1770 (6.2%)	1514 (5.3%)	<0.001
Number of children in family	2 (1, 2)	2 (1, 2)	>0.9
Uncontrolled Asthma^b	4548 (16%)		N/A
Exacerbating Asthma	2231 (7.8%)		N/A
Moderate exacerbations	585 (2.0%)		N/A
Severe exacerbations	1712 (6.0%)		N/A
Possible Severe Asthma^c	1359 (4.8%)		N/A
Family History of Asthma
≥1 sibling with asthma	3559 (12%)	0 (0%)
Parental asthma	11,791 (41%)	5621 (20%)
Maternal asthma	7671 (27%)	3317 (12%)
Paternal asthma	5531 (19%)	2641 (9.2%)
Non-respiratory Charlson score
Family total score	0.00 (0.00, 0.00)	0.00 (0.00, 0.00)	<0.001
Score ≥2	1121 (3.9%)	539 (1.9%)	<0.001

Notes: ^aStatistics presented: n (%); median (IQR); ^bdefined as >400/600 annual doses of short-acting bronchodilators for ages 0–11/12+. ^cDefined as GINA Step 3+4 with two moderate or one severe exacerbation(s) for ages 0–11, GINA Step 4 with two moderate or one severe exacerbation(s) or GINA Step 5 regardless of exacerbations for ages 12 and above.

Abbreviation: GINA, Global Initiative for Asthma.

Table 2 Socioeconomic Characteristics of Families with Children with Actively Treated Asthma and of Control Families

	Cases (N = 28,595)	Controls (N = 28,595)^a	P-value
Family Highest Education Level
Basic Education	3271 (12%)	3271 (12%)	>0.9
Vocational Education	10,463 (37%)	10,463 (37%)
Higher Education	14,285 (51%)	14,285 (51%)
Family Disposable Income^b
1st Quartile	4590 (16%)	4590 (16%)	>0.9
2nd Quartile	5852 (20%)	5852 (20%)
3rd Quartile	9893 (35%)	9893 (35%)
4th Quartile	8260 (29%)	8260 (29%)
Family Highest Socioeconomic Position
Employed/Self-employed	26304 (92%)	26308 (92%)	0.4
Currently Undergoing Education	295 (1.0%)	324 (1.1%)
Transfer Income Recipients	1818 (6.4%)	1743 (6.1%)
Retirees or Unclassifiable	96 (0.3%)	93 (0.3%)
Family City of Residence Size
Major Copenhagen Area	5813 (20%)	5813 (20%)	>0.9
Major City	2749 (9.6%)	2749 (9.6%)
Medium-sized City	7886 (28%)	7886 (28%)
Small City	6738 (24%)	6738 (24%)
Rural Area	5409 (19%)	5409 (19%)

Notes: ^aStatistics presented: n (%); median (IQR); ^bquartiles calculated according to the Danish national population’s disposable income for the case’s index year. Families matched by maternal age, family disposable income, family highest attained education, number of siblings, inhabitant number of municipality of residence.

Figure 2 Odds for antidepressant use in families of children with actively treated asthma and 1:1 matched control families. Analyses adjusted for matching variables, children’s age, and family non-respiratory Charlson score.

Table 3 Predictors of Caregiver Antidepressant Use in Families of Children with Actively Treated Asthma Compared to Control Families

	Odds Ratio	95% Confidence Interval	P-value
Asthma
Controls	Ref.
Actively Treated Asthma	1.29	1.23, 1.35	<0.001
Family Highest Education Level
Basic Education	Ref.
Vocational Education	0.92	0.85, 0.99	0.036
Higher Education	0.85	0.78, 0.92	<0.001
Family Disposable Income^a
1st Quartile	Ref.
2nd Quartile	0.94	0.87, 1.01	0.11
3rd Quartile	0.62	0.57, 0.67	<0.001
4th Quartile	0.43	0.39, 0.47	<0.001
Family Highest Socioeconomic Position
Employed/Self-employed	Ref.
Currently Under Education	0.95	0.76, 1.18	0.7
Transfer Income Recipients	1.90	1.73, 2.08	<0.001
Retirees or Unclassifiable	0.64	0.39, 098	0.051
Family City of Residence Size
Major Copenhagen Area	Ref.
Major City	1.40	1.27, 1.53	<0.001
Medium-sized City	1.35	1.26, 1.46	<0.001
Small City	1.43	1.33, 1.55	<0.001
Rural Area	1.42	1.31, 1.54	<0.001
Child Age	1.02	1.02, 1.03	<0.001
Family Non-respiratory Charlson Score	1.12	1.07, 1.16	<0.001

Note: ^aQuartiles calculated according to the Danish national population’s disposable income for the case’s index year.

Table 4 The Distribution of Parental Antidepressant Use Based on Inhaled Corticosteroid Dosing of Children with Actively Treated Asthma

	Parental Antidepressant Use (N = 4823)	No Parental Antidepressant Use (N = 23,772)	P-value^a
Inhaled Corticosteroid Dose
Below Low	1135 (25%)	5026 (21%)	0.002
Low	1482 (31%)	7658 (32%)
Medium	1406 (29%)	7131 (30%)
High	800 (17%)	3957 (17%)

Notes: ^aStatistics presented: n (%), Pearson’s Chi-squared test.

Figure 3 Odds for adverse asthma outcomes in children with actively treated asthma with parental antidepressant use. Analyses adjusted for size of city of residence, families’ disposable income, families’ highest education, children’s age, and family non-respiratory Charlson score.