Childcare attendance and risk of infectious mononucleosis: A population-based Danish cohort study
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Childcare attendance and risk of infectious mononucleosis : A population-based Danish cohort study. / Rostgaard, Klaus; Stensballe, Lone Graff; Søegaard, Signe Holst; Kamper-Jørgensen, Mads; Hjalgrim, Henrik.
In: PLoS ONE, Vol. 16, No. 12, e0261665, 2021.Research output: Contribution to journal › Journal article › peer-review
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TY - JOUR
T1 - Childcare attendance and risk of infectious mononucleosis
T2 - A population-based Danish cohort study
AU - Rostgaard, Klaus
AU - Stensballe, Lone Graff
AU - Søegaard, Signe Holst
AU - Kamper-Jørgensen, Mads
AU - Hjalgrim, Henrik
PY - 2021
Y1 - 2021
N2 - BACKGROUND: The risk of infectious mononucleosis (IM) is affected both by crowding and by sibship structure, i.e., number and signed age differential between an index child and a sibling. Siblings provide protection against IM by pre-empting delayed primary Epstein-Barr virus infection with its associated high risk of IM. The association between childcare attendance and risk of IM, on the other hand, has never been studied in a large, well-characterized cohort.METHODS: Danish children born in July 1992 through 2016 with a completely known simple childcare attendance history before age 1.5 years (n = 908,866) were followed up for a hospital contact with an IM diagnosis at ages 1.5-26 years. Hazard ratios (HRs) of IM for an additional year of exposure were obtained from stratified Cox regression analyses, stratified by sex and year of birth, with age as the underlying time scale, adjusted for sibship structure, and sociodemographic variables including parental ethnicity and maternal age.RESULTS: An additional year of exclusively attending a daycare home (max 5 children) yielded HR = 0.90 (95% confidence interval 0.81-1.00), and similarly, each year of exclusively attending a childcare institution (e.g., crèche) yielded HR = 0.94 (0.84-1.06).CONCLUSIONS: Forwarding enrollment in childcare by a year lowers the risk of IM later in life much less than having an additional sibling of comparable age and has no practical public health implications. We find our results suggestive of a random threshold for successful Epstein-Barr virus infection that is more easily reached by a sibling than the collective of playmates in daycare homes or childcare institutions.
AB - BACKGROUND: The risk of infectious mononucleosis (IM) is affected both by crowding and by sibship structure, i.e., number and signed age differential between an index child and a sibling. Siblings provide protection against IM by pre-empting delayed primary Epstein-Barr virus infection with its associated high risk of IM. The association between childcare attendance and risk of IM, on the other hand, has never been studied in a large, well-characterized cohort.METHODS: Danish children born in July 1992 through 2016 with a completely known simple childcare attendance history before age 1.5 years (n = 908,866) were followed up for a hospital contact with an IM diagnosis at ages 1.5-26 years. Hazard ratios (HRs) of IM for an additional year of exposure were obtained from stratified Cox regression analyses, stratified by sex and year of birth, with age as the underlying time scale, adjusted for sibship structure, and sociodemographic variables including parental ethnicity and maternal age.RESULTS: An additional year of exclusively attending a daycare home (max 5 children) yielded HR = 0.90 (95% confidence interval 0.81-1.00), and similarly, each year of exclusively attending a childcare institution (e.g., crèche) yielded HR = 0.94 (0.84-1.06).CONCLUSIONS: Forwarding enrollment in childcare by a year lowers the risk of IM later in life much less than having an additional sibling of comparable age and has no practical public health implications. We find our results suggestive of a random threshold for successful Epstein-Barr virus infection that is more easily reached by a sibling than the collective of playmates in daycare homes or childcare institutions.
U2 - 10.1371/journal.pone.0261665
DO - 10.1371/journal.pone.0261665
M3 - Journal article
C2 - 34937060
VL - 16
JO - PLoS ONE
JF - PLoS ONE
SN - 1932-6203
IS - 12
M1 - e0261665
ER -
ID: 288179607