Send to:

Choose Destination
See comment in PubMed Commons below
J Allergy Clin Immunol. 2014 Apr;133(4):979-88. doi: 10.1016/j.jaci.2013.11.035. Epub 2014 Jan 22.

Early-life determinants of asthma from birth to age 20 years: a German birth cohort study.

Author information

  • 1Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany. Electronic address:
  • 2Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany.
  • 3Centre for Pediatric and Adolescent Medicine, University Medical Centre Mainz, Mainz, Germany.
  • 4Department of Pediatrics, St Josefs Hospital, Freiburg, Germany.
  • 5Department of Pediatrics, Heinrich-Heine-University, Düsseldorf, Germany.
  • 6Department of Pediatrics, Technical University of Munich, Munich, Germany.
  • 7Department of Pediatrics, Westmecklenburg Hospital, Hagenow, Germany.
  • 8Department of Pediatric Pneumology and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
  • 9Department of Obstetrics, Charité-Universitätsmedizin Berlin, Berlin, Germany.
  • 10Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany; Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.



The lack of longitudinal data analyses from birth to adulthood is hampering long-term asthma prevention strategies.


We aimed to determine early-life predictors of asthma incidence up to age 20 years in a birth cohort study by applying time-to-event analysis.


In 1990, the Multicenter Allergy Study included 1314 newborns in 5 German cities. Children were evaluated from birth to age 20 years at 19 time points. Using a Cox regression model, we examined the associations between 36 early-life factors and onset of asthma based on a doctor's diagnosis or asthma medication (primary outcome), typical asthma symptoms, or allergic asthma (including positive IgE measurements).


Response at 20 years was 71.6%. Two hundred eighteen subjects met the primary outcome criteria within 16,257 person years observed. Asthma incidence was lower in participants who were vaccinated (measles, mumps, and rubella vaccine/tick-borne encephalitis vaccine/BCG vaccine: adjusted hazard ratio [HR], 0.66 [95% CI, 0.47-0.93]). Up to age 20 years, asthma incidence was higher in subjects who had parents with allergic rhinitis (adjusted HR, 2.24 [95% CI, 1.67-3.02]), started day care early or late (before 18 months: adjusted HR, 1.79 [95% CI, 1.03-3.10]; after 3 years: adjusted HR, 1.64 [95% CI, 0.96-2.79]), had mothers who smoked during pregnancy (adjusted HR, 1.79 [95% CI, 1.20-2.67]), had poor parents (adjusted HR, 1.55 [95% CI, 1.09-2.22]), and had parents with asthma (adjusted HR, 1.65 [95% CI, 1.17-2.31]). Not associated with asthma were aspects of diet and breast-feeding, pet ownership, presence of older siblings, and passive smoking.


Parental asthma and nasal allergy increase asthma incidence in offspring up to adulthood. Avoiding tobacco smoke exposure during pregnancy, receiving vaccinations in early childhood, and starting day care between 1.5 and 3 years of age might prevent or delay the development of asthma.

Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.


Infant; adolescent; child; epidemiologic factors; heredity; hypersensitivity; immunization; preschool; risk factors; survival analysis

[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science
    Loading ...
    Write to the Help Desk