Highly prevalent and typically beginning in childhood, asthma is a burdensome disease, yet the risk factors for this condition are not clarified. To enhance understanding, this study assessed the cohort-specific and pooled risk of maternal education on asthma in children aged 3-8 across 10 European countries. Data on 47,099 children were obtained from prospective birth cohort studies across 10 European countries. We calculated cohort-specific prevalence difference in asthma outcomes using the relative index of inequality (RII) and slope index of inequality (SII). Results from all countries were pooled using random-effects meta-analysis procedures to obtain mean RII and SII scores at the European level. Final models were adjusted for child sex, smoking during pregnancy, parity, mother's age and ethnicity. The higher the score the greater the magnitude of relative (RII, reference 1) and absolute (SII, reference 0) inequity. The pooled RII estimate for asthma risk across all cohorts was 1.46 (95% CI 1.26, 1.71) and the pooled SII estimate was 1.90 (95% CI 0.26, 3.54). Of the countries examined, France, the United Kingdom and the Netherlands had the highest prevalence's of childhood asthma and the largest inequity in asthma risk. Smaller inverse associations were noted for all other countries except Italy, which presented contradictory scores, but with small effect sizes. Tests for heterogeneity yielded significant results for SII scores. Overall, offspring of mothers with a low level of education had an increased relative and absolute risk of asthma compared to offspring of high-educated mothers.

Biocenter Oulu University of Oulu Oulu Finland

BIODONOSTIA Health Research Institute San Sebastian Spain

Center for Global Health University of Illinois College of Medicine Chicago IL USA

Department of Clinical Epidemiology Predictive Medicine and Public Health University of Porto Medical School Porto Portugal

Department of Epidemiology and Biostatistics MRC Health Protection Agency Centre for Environment and Health School of Public Health Imperial College London London UK

Department of Epidemiology Lazio Regional Health System Rome Italy

Department of Medicine and Health Community Medicine General Practice Faculty of Health Sciences Linköping University Linköping Sweden

Department of Public Health Amsterdam Public Health Research Institute Academic Medical Center University of Amsterdam Amsterdam The Netherlands

Division of Pediatrics Department of Clinical and Experimental Medicin Linköping University Linköping Sweden

EPIUnit Institute of Public Health University of Porto Porto Portugal

Faculty of Medicine Center for Life Course Health Research University of Oulu Oulu Finland

IB Salut Menorca Health Area Balearic Islands Spain

Institut National de la Santé et de la Recherche Médicale Center for Epidemiology and Statistics Sorbonne Paris Cité DHU Risks in Pregnancy Paris Descartes University Paris France

Institut National de la Santé et de la Recherche Médicale Center for Epidemiology and Statistics Sorbonne Paris Cité Paris Descartes University Paris France

Institute of Biostatistics and Analyses Masaryk University Brno Czech Republic

Institute of Pediatrics Obstetrics and Gynecology National Academy of Medical Sciences of Ukraine Kiev Ukraine

ISGlobal Center for Research in Environmental Epidemiology Barcelona Spain

Joint Research Unit of Epidemiology and Environmental Health FISABIO Universitat Jaume 1 Universitat de Valéncia Castellón de la Plana Spain

Pierre Louis Institute of Epidemiology and Public Health Paris France

Public Health Department of Gipuzkoa Gipuzkoa Spain

Research Centre of Toxic Compounds in the Environment Faculty of Science Masaryk University Brno Czech Republic

Research Department of Epidemiology and Public Health UCL Institute of Health Equity University College London London UK

Research Department of Epidemiology and Public Health University College London 1 19 Torrington Place London WC1E 6BT UK

Spanish Consortium for Research on Epidemiology and Public Health Barcelona Spain

Unit of Primary Care Oulu University Hospital Oulu Finland

Universitat Pompeu Fabra Barcelona Spain

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