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Investigation into the increase in hay fever and eczema at age 16 observed between the 1958 and 1970 British birth cohorts

BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7110.717 (Published 20 September 1997) Cite this as: BMJ 1997;315:717
  1. Barbara K Butland, lecturer in medical statisticsa (b.nicholas{at}sghms.ac.uk),
  2. David P Strachan, reader in epidemiologya,
  3. Sarah Lewis, medical statisticianb,
  4. John Bynner, director, social statistics research unitc,
  5. Neville Butler, director, international centre for child studiesc,
  6. John Britton, reader in respiratory medicineb
  1. a Department of Public Health Sciences, St George's Hospital Medical School, London SW17 ORE
  2. b Division of Respiratory Medicine, University of Nottingham, City Hospital, Nottingham NG5 1PB
  3. c Social Statistics Research Unit, City University, London EC1V OHB
  1. Correspondence to: Ms Butland
  • Accepted 28 May 1997

Abstract

Objective: To investigate whether changes in certain perinatal and social factors explain the increased prevalence of hay fever and eczema among British adolescents between 1974 and 1986.

Design: Two prospective birth cohort studies.

Setting: England, Wales, and Scotland.

Subjects: 11 195 children born 3-9 March 1958 and 9387 born 5-11 April 1970.

Main outcome measures: Parental reports of eczematous rashes and of hay fever or allergic rhinitis in the previous 12 months at age 16.

Results: The prevalence of the conditions over the 12 month period increased between 1974 and 1986 from 3.1% to 6.4% (prevalence ratio 2.04 (95% confidence interval 1.79 to 2.32) for eczema and from 12.0% to 23.3% (prevalence ratio 1.93 (1.82 to 2.06)) for hay fever. Both conditions were more commonly reported among children of higher birth order and those who were breast fed for longer than 1 month. Eczema was more commonly reported among girls and hay fever among boys. The prevalence of hay fever decreased sharply between social classes I and V, increased with maternal age up to the early 30s, and was lower in children whose mothers smoked during pregnancy. Neither condition varied significantly with birth weight. When adjusted for these factors, the relative odds of hay fever (1986 v 1974) increased from 2.23 (2.05 to 2.43) to 2.40 (2.19 to 2.63). Similarly, the relative odds of eczema rose from 2.02 (1.73 to 2.36) to 2.14 (1.81 to 2.52).

Conclusions: Taken together, changes between cohorts in sex, birth weight, birth order, maternal age, breast feeding, maternal smoking during pregnancy, and father's social class at birth did not seem to explain any of the observed rise in the prevalence of hay fever and eczema. However, correlates of these factors which have changed over time may still underlie recent increases in allergic disease.

Key messages

Key messages

  • Between 1974 and 1986 there was an apparent doubling in the 12 month period prevalence of both hay fever and eczema among British 16 year olds

  • The prevalence of hay fever increased significantly with higher social class and decreasing birth order, both trends being steeper for children born in 1958 than for those born in 1970

  • Hay fever was less common if the mother smoked during pregnancy and more common with increasing maternal age up to the early 30s. The prevalences of hay fever and eczema were slightly higher among children breast fed for more than one month

  • When taken together, differences in sex, birth weight, birth order, maternal age, breast feeding, maternal smoking during pregnancy, and father's social class at birth between children born in 1958 and those born in 1970 did not seem to explain any of the observed increases in prevalence of hay fever and eczema at age 16

  • Factors related to father's social class at birth, birth order, maternal age, smoking during pregnancy, and breast feeding deserve further investigation as possible explanations of the increase in atopic disease in Britain and elsewhere

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