M E Schram1, A M Tedja, R Spijker, J D Bos, H C Williams, Ph I Spuls. 1. Department of Dermatology, A0-252, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DD Amsterdam, the Netherlands. M.E.Schram@amc.uva.nl
Abstract
BACKGROUND: Eczema affects approximately 10% of all schoolchildren in the western world and has shown an increase over the past decades in 'developing' countries. Numerous factors have been suggested that might contribute to the increasing prevalence of eczema. A plausible explanation is the role of environmental factors. As part of the 'hygiene hypothesis' it has been thought that eczema is more common in urban than in rural communities, but such a notion has never been assessed systematically. OBJECTIVE: Our aim was to assess whether there is a rural/urban gradient for the prevalence of eczema and, if so, to what extent. METHODS: All data sources were identified through a search in MEDLINE and EMBASE. All primary studies comparing the prevalence rate of eczema between urban and rural populations were assessed for eligibility. Included articles were reviewed for methodological quality and a relative risk was calculated to indicate the risk of eczema in urban over rural areas. Results Twenty-six articles were included for analysis. Nineteen showed a higher risk for eczema in an urbanized area, of which 11 were significant. Six studies showed a lower risk of eczema in an urbanized area, of which one was statistically significant. One study had a relative risk of 1.00. RESULTS: were more homogeneous among studies of good methodological quality. A pooled relative risk could have been calculated but was not because of heterogeneity. CONCLUSION: There is some evidence of a higher risk for eczema in urban compared with rural areas, suggesting that place of residence may have a role in the pathogenesis of eczema. Future reviews on environmental circumstances should be carried out to reveal the factors associated with a higher prevalence of eczema in urban areas and the association with other allergic diseases.
BACKGROUND:Eczema affects approximately 10% of all schoolchildren in the western world and has shown an increase over the past decades in 'developing' countries. Numerous factors have been suggested that might contribute to the increasing prevalence of eczema. A plausible explanation is the role of environmental factors. As part of the 'hygiene hypothesis' it has been thought that eczema is more common in urban than in rural communities, but such a notion has never been assessed systematically. OBJECTIVE: Our aim was to assess whether there is a rural/urban gradient for the prevalence of eczema and, if so, to what extent. METHODS: All data sources were identified through a search in MEDLINE and EMBASE. All primary studies comparing the prevalence rate of eczema between urban and rural populations were assessed for eligibility. Included articles were reviewed for methodological quality and a relative risk was calculated to indicate the risk of eczema in urban over rural areas. Results Twenty-six articles were included for analysis. Nineteen showed a higher risk for eczema in an urbanized area, of which 11 were significant. Six studies showed a lower risk of eczema in an urbanized area, of which one was statistically significant. One study had a relative risk of 1.00. RESULTS: were more homogeneous among studies of good methodological quality. A pooled relative risk could have been calculated but was not because of heterogeneity. CONCLUSION: There is some evidence of a higher risk for eczema in urban compared with rural areas, suggesting that place of residence may have a role in the pathogenesis of eczema. Future reviews on environmental circumstances should be carried out to reveal the factors associated with a higher prevalence of eczema in urban areas and the association with other allergic diseases.
Authors: Lawrence F Eichenfield; Wynnis L Tom; Sarah L Chamlin; Steven R Feldman; Jon M Hanifin; Eric L Simpson; Timothy G Berger; James N Bergman; David E Cohen; Kevin D Cooper; Kelly M Cordoro; Dawn M Davis; Alfons Krol; David J Margolis; Amy S Paller; Kathryn Schwarzenberger; Robert A Silverman; Hywel C Williams; Craig A Elmets; Julie Block; Christopher G Harrod; Wendy Smith Begolka; Robert Sidbury Journal: J Am Acad Dermatol Date: 2013-11-27 Impact factor: 11.527
Authors: Elizabeth T Jensen; Kate Hoffman; Nicholas J Shaheen; Robert M Genta; Evan S Dellon Journal: Am J Gastroenterol Date: 2014-03-25 Impact factor: 10.864
Authors: Steven J Ersser; Fiona Cowdell; Sue Latter; Eric Gardiner; Carsten Flohr; Andrew Robert Thompson; Karina Jackson; Helen Farasat; Fiona Ware; Alison Drury Journal: Cochrane Database Syst Rev Date: 2014-01-07
Authors: Joel T M Bamford; Sujoy Ray; Alfred Musekiwa; Christel van Gool; Rosemary Humphreys; Edzard Ernst Journal: Cochrane Database Syst Rev Date: 2013-04-30