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Disease in childhood and the impact of childcare

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3 7 0 D A N I S H M E D I C A L B U L L E T I N V O L. 5 4N O. 4 / NO V E M B E R 2 0 0 7

ABSTRACT OF DISSERTATION

Disease in childhood

and the impact of childcare

Mads Kamper-Jørgensen, MSc, PhD

This PhD dissertation was accepted by The Faculty of Health Sciences, Uni- versity of Copenhagen, and defended on April 30, 2007.

Official opponentets: Freddy Karup Pedersen, Henrik Toft Sørensen, and Per Magnus.

Tutors: Jan Wohlfahrt and Christine Stabell Benn.

Correspondence: Mads Kamper-Jørgensen, Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Den- mark.

E-mail: mka@ssi.dk Dan Med Bull 2007;54:370 ABSTRACT

The PhD dissertation is based on five epidemiological studies of Danish register data regarding infection-related hospitalizations, childhood acute lymphoblastic leukemia (ALL) and attendance to childcare facilities in children aged 0-5 years in the period 1989- 2004. The overall aim of the thesis was to study the impact of child- care attendance on disease in childhood on a short and a long-term basis, respectively. Short-term impact of childcare attendance was studied using hospitalizations for acute respiratory infections (ARI) as outcome, whereas ALL was studied to evaluate the long-term im- pact of childcare.

Initially, temporal trends in the incidence of hospitalizations for childhood infections in the period 1980-2001 in Denmark were characterized. We found an increase in the incidence of hospitaliza- tions for infections, almost exclusively driven by short-term hospi- talizations in 0-1-year-old children. Secondly, we described the cre- ation of, the information available in, and the potential of the Child- care Database, containing more than 1 million children and created for the purpose of the present thesis. Thirdly, we assessed the short- term impact of childcare attendance on ARI. We found that child- care attendance was associated with an excess risk of ARI hospitali- zation, but only in 0-2-year-olds, during the first period of enroll- ment and in children not living with other children. Fourthly, we studied factors related to clustering of ARI in childcare facilities. We found that ARI hospitalizations cluster among children in childcare facilities. Clusters involved 0-2-year-olds and boys as first hospital- ized child relatively more often than other children. Finally, we studied whether attendance to childcare early in life was associated with childhood ALL. We found childcare attendance during the first two years of life to entail a reduced risk of childhood ALL and the studied child and family characteristics seemed to play a minor role in the association between childcare attend-ance and childhood ALL.

We have confirmed an increased infection hospitalization inci- dence over time, documented the establishment of the Childcare Database, and confirmed that childcare attendance is associated with an increased risk of ARI hospitalization and a decreased risk of childhood ALL. The thesis contributes with new knowledge by iden- tifying subgroups of children involved in the increased infection hospitalization incidence over time, and by demonstrating that the association between childcare attendance and ARI hospitalization varies with characteristics of the child and the child’s family, whereas these characteristics seem to play a minor role in the associ- ation between childcare attendance and childhood ALL.

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