Childhood eczema: disease of the advantaged?

Abstract

Objective: To determine whether the increased prevalence of childhood eczema in advantaged socioeconomic groups is due to increased parental reporting.

Design: Comparison of parental reports of eczema with visible eczema recorded by medical officers during a detailed physical examination.

Setting: National birth cohort study.

Subjects: 8279 children from England, Wales, and Scotland born during 3-9 March 1958 and followed up at the ages of 7, 11, and 16.

Main outcome measures: Prevalence of eczema according to parental report compared with medical officer's examination at the ages of 7, 11, and 16.

Results: Prevalence of both reported and examined eczema increased with rising social class at the ages of 7, 11, and 16 years. The point prevalence of examined eczema at age 7 was 4.8%, 3.6%, 3.6%, 2.4%, 2.2%, and 2.4% in social classes I, II, III non-manual, III manual, IV, and V respectively (chi 2 value for linear trend 12.6, P < 0.001). This trend persisted after adjustment for potential confounders such as region and family size and was not present for examined psoriasis or acne.

Conclusions: Eczema is more prevalent among British schoolchildren in social classes I and II than those in lower classes. Exposures associated with social class are probably at least as important as genetic factors in the expression of childhood eczema.