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Original Investigation |

Early Exposure to Dogs and Farm Animals and the Risk of Childhood Asthma Online Only

Tove Fall, PhD1; Cecilia Lundholm, MSc2; Anne K Örtqvist, PhD2; Katja Fall, PhD3,4; Fang Fang, PhD2; Åke Hedhammar, PhD5; Olle Kämpe, PhD6; Erik Ingelsson, PhD1; Catarina Almqvist, PhD2,7
[+] Author Affiliations
1Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
2Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
3Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
4School of Health and Medical Sciences, Örebro University, Örebro, Sweden
5Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
6Centre for Molecular Medicine, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
7Astrid Lindgren Children’s Hospital, Lung and Allergy Unit, Karolinska University Hospital, Stockholm, Sweden
JAMA Pediatr. 2015;169(11):e153219. doi:10.1001/jamapediatrics.2015.3219.
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Importance  The association between early exposure to animals and childhood asthma is not clear, and previous studies have yielded contradictory results.

Objective  To determine whether exposure to dogs and farm animals confers a risk of asthma.

Design, Setting and Participants  In a nationwide cohort study, the association between early exposure to dogs and farm animals and the risk of asthma was evaluated and included all children born in Sweden from January 1, 2001, to December 31, 2010 (N = 1 011 051), using registry data on dog and farm registration, asthma medication, diagnosis, and confounders for parents and their children. The association was assessed as the odds ratio (OR) for a current diagnosis of asthma at age 6 years for school-aged children and as the hazard ratio (HR) for incident asthma at ages 1 to 5 years for preschool-aged children. Data were analyzed from January 1, 2007, to September 30, 2012.

Exposures  Living with a dog or farm animal.

Main Outcomes and Measures  Childhood asthma diagnosis and medication used.

Results  Of the 1 011 051 children born during the study period, 376 638 preschool-aged (53 460 [14.2%] exposed to dogs and 1729 [0.5%] exposed to farm animals) and 276 298 school-aged children (22 629 [8.2%] exposed to dogs and 958 [0.3%] exposed to farm animals) were included in the analyses. Of these, 18 799 children (5.0%) in the preschool-aged children’s cohort experienced an asthmatic event before baseline, and 28 511 cases of asthma and 906 071 years at risk were recorded during follow-up (incidence rate, 3.1 cases per 1000 years at risk). In the school-aged children’s cohort, 11 585 children (4.2%) experienced an asthmatic event during the seventh year of life. Dog exposure during the first year of life was associated with a decreased risk of asthma in school-aged children (OR, 0.87; 95% CI, 0.81-0.93) and in preschool-aged children 3 years or older (HR, 0.90; 95% CI, 0.83-0.99) but not in children younger than 3 years (HR, 1.03; 95% CI, 1.00-1.07). Results were comparable when analyzing only first-born children. Farm animal exposure was associated with a reduced risk of asthma in both school-aged children and preschool-aged children (OR, 0.48; 95% CI, 0.31-0.76, and HR, 0.69; 95% CI, 0.56-0.84), respectively.

Conclusions and Relevance  In this study, the data support the hypothesis that exposure to dogs and farm animals during the first year of life reduces the risk of asthma in children at age 6 years. This information might be helpful in decision making for families and physicians on the appropriateness and timing of early animal exposure.

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Data Source Overview

Nine Swedish national registries were used for the study and records were linked using the Personal Identity Number.

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