Intergenerational 20 year trends in the prevalence of asthma and hay fever in adults: the Midspan family study surveys of parents and offspring

doi:10.1136/bmj.321.7253.88

BMJ 2000;321:88-92 ( 8 July )

General Practice

Intergenerational 20 year trends in the prevalence of asthma and hay fever in adults: the Midspan family study surveys of parents and offspring

Mark N Upton, Wellcome Trust research training fellow in clinical epidemiology, ^a Alex McConnachie, statistician, ^a Charles McSharry, principal scientist, ^b Carole L Hart, statistician, ^c George Davey Smith, professor of clinical epidemiology, ^d Charles R Gillis, professor, west of Scotland cancer surveillance unit, ^c Graham C M Watt, professor of general practice. ^a

^a Department of General Practice, University of Glasgow, Glasgow G12 0RR, ^b Department of Immunology, Western Infirmary, Glasgow G11 6NT, ^c Department of Public Health, University of Glasgow, Glasgow G12 8RZ, ^d Department of Social Medicine, University of Bristol, Bristol BS8 2PR

Correspondence to: M N Upton, Thornaby and Barwick Medical Group, The Health Centre, Thornaby, Cleveland TS17 0BZ marknupton{at}aol.com

Objective: To estimate trends between 1972-6 and 1996in the prevalences of asthma and hay fever inadults.
Design: Two epidemiological surveys 20 years apart.Identical questions were asked about asthma, hay fever, and respiratorysymptoms at eachsurvey.
Setting: Renfrew and Paisley, two towns in the westofScotland.
Subjects: 1477 married couples aged 45-64 participatedin a general population survey in 1972-6; and 2338 offspring aged30-59 participated in a 1996 survey. Prevalences were comparedin 1708 parents and 1124 offspring aged 45-54.
Main outcome measures: Prevalences of asthma, hay fever, and respiratorysymptoms.
Results: In never smokers, age and sex standardisedprevalences of asthma and hay fever were 3.0% and 5.8% respectivelyin 1972-6, and 8.2% and 19.9% in 1996. In ever smokers, the correspondingvalues were 1.6% and 5.4% in 1972-6 and 5.3% and 15.5% in 1996.In both generations, the prevalence of asthma was higher in thosewho reported hay fever (atopic asthma). In never smokers, reportsof wheeze not labelled as asthma were about 10 times more commonin 1972-6 than in 1996. With a broader definition of asthma (asthmaand/or wheeze), to minimise diagnostic bias, the overall prevalenceof asthma changed little. However, diagnostic bias mainly affectednon-atopic asthma. Atopic asthma increased more than twofold (prevalenceratio 2.52 (95% confidence interval 1.01 to 6.28)) whereas theprevalence of non-atopic asthma did not change (1.00 (0.53 to1.90)).
Conclusion: The prevalence of asthma in adults has increasedmore than twofold in 20 years, largely in association with trendsin atopy, as measured indirectly by the prevalence of hay fever.No evidence was found for an increase in diagnostic awarenessbeing responsible for the trend in atopic asthma, but increasedawareness may account for trends in non-atopicasthma.

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