Rhinitis, sinusitis, and upper airway disease
Early-life risk factors and incidence of rhinitis: Results from the European Community Respiratory Health Study—an international population-based cohort study

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Background

Rhinitis is an increasingly common condition with a heavy health care burden, but relatively little is known about its risk factors.

Objective

To examine the association between early-life factors and the development of rhinitis in the European Community Respiratory Health Study (ECRHS).

Methods

In 1992-1994, community-based samples of 20-44-year-old people were recruited from 48 centers in 22 countries. On average, 8.9 years later, 28 centers reinvestigated their samples. Onset of rhinitis was reported by 8486 participants in interviewer-led questionnaires. Cox regression was used to assess independent predictors of rhinitis at ages ≤5, 6-10, 11-20, and ≥21 years.

Results

The crude lifelong incidence of rhinitis was 7.00/1000/year (men) and 7.95/1000/year (women) (P = .002). Women developed less rhinitis in later childhood (hazard ratios [HR], 0.63; 95% CI, 0.47-0.85) and more rhinitis in adulthood (HR, 1.36; 95% CI, 1.11-1.66) than did men. In atopic subjects, siblings were associated with lower risk of rhinitis throughout life (pooled HR, 0.94; 95% CI, 0.91-0.98 per 1 sibling). Early contact with children in the family or day care was associated with less incidence of rhinitis, predominantly before age 5 years (HR, 0.84; 95% CI, 0.72-0.99). Early childhood pets or growing up on a farm was associated with less incidence of rhinitis in adolescence (HR, 0.50; 95% CI, 0.37-0.68). Combining these factors showed evidence of a dose-response relationship (trend P = .0001).

Conclusions

Gender is a strong risk factor for rhinitis, with age patterns varying according to atopic status. Protective effects of early contact with children and animals were suggested for incident rhinitis, with risk patterns varying by age window and atopic status.

Section snippets

Study subjects and data collection

The ECRHS is a prospective population-based cohort study of respiratory health among adults in 28 study centers in 13 countries. The study design and methods have been described previously13, 14 (www.ecrhs.org). Briefly, between 1991 and 1993, 48 study centers in 22 countries participated in ECRHS I, which comprised 2 stages. Each participating center selected a random sample of 1500 men and 1500 women aged between 20 and 44 years. These study subjects were mailed a screening questionnaire in

Results

Out of 8486 participants in ECRHS II 2,352 (27.7%) reported rhinitis. The crude lifelong incidence of rhinitis was 7.00/1000/year in males and 7.95/1000/year in females (log-rank test for equality P = .002; see Fig E1 in this article’s Online Repository at www.jacionline.org ). The crude incidence rates of rhinitis overall and stratified by allergic sensitization are presented in Table I. Overall rhinitis increased over time in both males and females, with the peak incidence in both males and

Discussion

This is the first study to examine the influence of early-life exposures on lifetime incidence of rhinitis in a large international population-based sample. Until now there have been only a few studies of the natural history of rhinitis and these have been limited to reports of incidence by age and gender15 or medical databases with limited information on early-life exposures.16 Furthermore, we have shown for the first time an important protective effect of siblings and pet exposure on the

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    M.C. Matheson and S.C. Dharmage are supported by the National Health and Medical Research Council of Australia. The ECRHS study is a joint project by many participants and funded by many sources. See the Acknowledgments section for complete funding and study information.

    Disclosure of potential conflict of interest: S.C. Dharmage has received research support from the National Health and Medical Research Council (Australia) and the Clifford Craig Medical Trust. M.J. Abramson is the chair of the Australian Lung Foundation’s guidelines committee. E.H. Walters has received research support from GlaxoSmithKline. M. Wjst is married to an employee of Bencard. The rest of the authors have declared that they have no conflict of interest.

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