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American Journal of Epidemiology Advance Access originally published online on March 15, 2008
American Journal of Epidemiology 2008 167(10):1182-1187; doi:10.1093/aje/kwn042
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American Journal of Epidemiology © 2008 The Authors
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.0/uk/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ORIGINAL CONTRIBUTIONS

Eczema, Birth Order, and Infection

Ann Maree Hughes, Simon Crouch, Tracy Lightfoot, Pat Ansell, Jill Simpson and Eve Roman

From the Epidemiology and Genetics Unit, Department of Health Sciences, University of York, Heslington, York, United Kingdom

Correspondence to Dr. Eve Roman, Epidemiology and Genetics Unit, Department of Health Sciences, Seebohm Rowntree Building (Area 3), University of York, Heslington, York YO10 5DD, United Kingdom (e-mail: er18{at}york.ac.uk).

Received for publication September 7, 2007. Accepted for publication February 6, 2008.

The association between infections occurring in the first 2 years of life and development of eczema was investigated in 1,782 control children from a national population-based case-control study in the United Kingdom conducted over the period 1991–1996. Dates of eczema and infectious diagnoses were ascertained from contemporaneously collected primary care records. Children diagnosed with eczema before the age of 2 years had more prior clinically diagnosed infections recorded than did children without eczema (rate ratio = 1.26, 95% confidence interval (CI): 1.18, 1.36). The difference in infection rates between children with and without eczema was apparent from birth and throughout the first 2 years of life. As expected, compared with children of second or higher birth order, those firstborn were at increased risk of eczema (p = 0.020); however, the relation between eczema and prior infection was evident only among children of second or higher birth order and not among firstborn children (rate ratio = 1.45, 95% CI: 1.32, 1.59, and rate ratio = 1.08, 95% CI: 0.98, 1.20, respectively). The authors' results are consistent with the notion that the association between birth order and eczema is unlikely to be attributable to variations in early infectious exposure.

birth order; child; eczema; hygiene; infection

Abbreviations: CI, confidence interval; GP, general practitioner; ICD-10, International Classification of Diseases, Tenth Revision; UKCCS, United Kingdom Childhood Cancer Study


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