Abstract
SummaryBackgroundAtopic dermatitis (eczema) in childhood is socially patterned, with higher incidence in more advantaged populations. However, it is unclear what factors explain the social differences.ObjectivesTo identify early‐life risk factors for eczema, and to explore how early‐life risk factors explain any differences in eczema.MethodsWe estimated odds ratios (ORs) for ever having had eczema by age 5 years in 14 499 children from the U.K. Millennium Cohort Study (MCS), with a focus on maternal, antenatal and early‐life risk factors and socioeconomic circumstances (SECs). Risk factors were explored to assess whether they attenuated associations between SECs and eczema.ResultsOverall 35·1% of children had ever had eczema by age 5 years. Children of mothers with degree‐level qualifications vs. no educational qualifications were more likely to have eczema (OR 1·52, 95% confidence interval 1·31–1·76), and there was a gradient across the socioeconomic spectrum. Maternal atopy, breastfeeding (1–6 weeks and ≥ 6 months), introduction of solids under 4 months or cow's milk under 9 months, antibiotic exposure in the first year of life and grime exposure were associated with an increased odds of having eczema. Female sex, Pakistani and Bangladeshi ethnicity, smoking during pregnancy, exposure to environmental tobacco smoke and having more siblings were associated with reduced odds for eczema. Controlling for maternal, antenatal and early‐life characteristics (particularly maternal smoking during pregnancy, breastfeeding and number of siblings) reduced the OR for eczema to 1·26 (95% confidence interval 1·03–1·50) in the group with the highest educational qualifications compared with the least.ConclusionsIn a representative U.K. child cohort, eczema was more common in more advantaged children. This was explained partially by early‐life factors including not smoking during pregnancy, breastfeeding and having fewer siblings.
Highlights
Childhood eczema is the most common inflammatory skin disease, and previous estimates suggest that it affects around 20% of children in the U.K.1 The condition is referred to as atopic dermatitis and atopic eczema
In a representative U.K. child cohort, eczema was more common in more advantaged children
Previous studies have suggested that atopic dermatitis in childhood is socially patterned, with higher incidence in more advantaged populations
Summary
Childhood eczema is the most common inflammatory skin disease, and previous estimates suggest that it affects around 20% of children in the U.K.1 The condition is referred to as atopic dermatitis and atopic eczema. Childhood eczema is the most common inflammatory skin disease, and previous estimates suggest that it affects around 20% of children in the U.K.1. The condition is referred to as atopic dermatitis and atopic eczema. It is characterized by itch, skin inflammation, a skin barrier abnormality and susceptibility to skin infection.[2] Childhood eczema can have a serious effect on children’s and families’ quality of life, for example through a negative impact on sleep, and has been shown to influence schooling.[2] The resulting impairment in health-related quality of life is comparable with that of other chronic diseases of childhood, including diabetes and asthma.[3]. Given the large public health burden and unclear risk factor profile, it is important that studies identify potentially modifiable risk factors for eczema that are amenable to public health intervention, and there is increasing evidence that early-life environmental exposures may be important.[6]
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