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Antibiotics in fetal and early life and subsequent childhood asthma: nationwide population based study with sibling analysis
Dept Med Epidemiol & Biostat, Karolinska Inst, Stockholm, Sweden.
Dept Med Epidemiol & Biostat, Karolinska Inst, Stockholm, Sweden.ORCID iD: 0000-0002-6546-3650
Dept Med, Ctr Pharmacoepidemiol T2, Karolinska Univ Hosp, Stockholm, Sweden.
Örebro University Hospital. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0003-1024-5602
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2014 (English)In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 349, article id g6979Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate the association between exposure to antibiotics in fetal and early life and asthma in childhood, with adjustment for confounding factors.

Design: Nationwide prospective population based cohort study, including sibling control design.

Setting: Swedish population identified from national demographic and health registers.

Participants: 493 785 children born 2006-10; 180 894 of these were eligible for sibling analyses.

Main outcome measure: Asthma defined as having both an asthma diagnosis and dispensed asthma drugs. The association between antibiotic exposure and asthma was investigated in the whole cohort with Cox proportional hazard regression. A stratified proportional hazards model conditional on sibling group was used to adjust for shared factors within families. Confounding by respiratory infections was assessed by investigating whether specific groups of antibiotics were associated with asthma.

Results: Antibiotic exposure in fetal life was associated with an increased risk of asthma in cohort analyses (hazard ratio 1.28, 95% confidence interval 1.25 to 1.32), but not in sibling analyses (0.99, 0.92 to 1.07). In cohort analyses, antibiotics used to treat respiratory infections in childhood were associated with a more pronounced increased risk of asthma (4.12, 3.78 to 4.50) than antibiotics used for urinary tract and skin infections (1.54, 1.24 to 1.92). In sibling analyses, the excess risks after exposure to antibiotics for respiratory infections decreased (2.36, 1.78 to 3.13) and disappeared for antibiotics for urinary tract and skin (0.85, 0.47 to 1.55).

Conclusions: Previous positive associations between exposure to antibiotics in fetal and early life and subsequent childhood asthma could have been caused by confounding by shared familial factors, in addition to confounding by respiratory infections.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2014. Vol. 349, article id g6979
National Category
General Practice
Identifiers
URN: urn:nbn:se:oru:diva-56693DOI: 10.1136/bmj.g6979ISI: 000346115900001PubMedID: 25432937Scopus ID: 2-s2.0-84914105594OAI: oai:DiVA.org:oru-56693DiVA, id: diva2:1083687
Funder
Swedish Heart Lung Foundation
Note

Funding Agencies:

Swedish Research Council through Swedish Initiative for Research on Microdata in the Social and Medical Sciences (SIMSAM) 2011-3060  80748301  340-2013-5867

Stockholm County Council (ALF project)

Karolinska Institutet

Available from: 2017-03-22 Created: 2017-03-22 Last updated: 2018-06-24Bibliographically approved

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