How do early weight trajectories explain social inequalities in lung function in children with cystic fibrosis? A longitudinal interventional disparity effects analysis with time-varying mediators and intermediate confounders.

Schlüter, Daniela K., Keogh, Ruth H., Daniel, Rhian M. ORCID: https://orcid.org/0000-0001-5649-9320, Agbla, Schadrac C. and Taylor-Robinson, David 2024. How do early weight trajectories explain social inequalities in lung function in children with cystic fibrosis? A longitudinal interventional disparity effects analysis with time-varying mediators and intermediate confounders. Epidemiology 10.1097/ede.0000000000001826

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Abstract

Background: Children with cystic fibrosis (CF) from socioeconomically deprived areas have poorer growth, worse lung function, and shorter life expectancy than their less-deprived peers. While early growth is associated with lung function around age 6, it is unclear whether improving early growth in the most deprived children reduces inequalities in lung function. Methods: We used data from the UK CF Registry, tracking children born 2000-2010 up to 2016. We extended the interventional disparity effects approach to the setting of a longitudinally measured mediator. Applying this approach, we estimated the association between socio-economic deprivation (children in the least versus most deprived population quintile; exposure) and lung function at first measurement (ages 6-8, outcome), and the role of early weight trajectories (ages 0-6) as mediators of this relationship. We adjusted for baseline confounding by sex, birthyear, and genotype and time-varying intermediate confounding by lung infection. Results: The study included 853 children, with 165 children from the least and 172 from the most deprived quintiles. The average lung function difference between the least and most deprived quintiles was 4.5% of predicted forced expiratory volume in 1 second (95% CI: 1.1 - 7.9). If the distribution of early weight trajectories in the most deprived children matched that in the least deprived children, this difference would reduce to 4% (95% CI: 0.57 – 7.4). Conclusion: Socio-economic deprivation has a strong negative association with lung function for children with CF. We estimate that improving early weight trajectories in the most deprived children would only marginally reduce these inequalities.

Item Type:	Article
Date Type:	Published Online
Status:	In Press
Schools:	Medicine
Publisher:	Lippincott, Williams & Wilkins
ISSN:	1044-3983
Date of First Compliant Deposit:	20 January 2025
Last Modified:	20 Jan 2025 10:30
URI:	https://orca.cardiff.ac.uk/id/eprint/175397

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