title: Increasing prevalence of recurrent otitis media among children in the United States.
abstract: BACKGROUND
  The number of visits for otitis media, the most common diagnosis among preschool children, has increased during the past decade. This study was undertaken to determine whether there has been a concurrent increase in the prevalence of recurrent otitis media among children in the United States and to identify risk factors or demographic changes to explain the increase.
  
  
  METHODS
  Secondary analyses of cross-sectional data from the Child Health Supplement to the 1981 and 1988 National Health Interview Surveys (n = 5189 [1981] and n = 6209 [1988]) were done to identify temporal changes in the prevalence and any associated risk factors of recurrent otitis media among children <6 years of age.
  
  
  RESULTS
  Recurrent otitis among preschool children increased from 18.7% in 1981 to 26% in 1988 (odds ratio [OR] = 1.6, 95% confidence interval [CI] = 1.4, 1.7). Although the prevalence of recurrent otitis increased with age, the greatest increase in recurrent otitis media occurred in infants (OR = 1.9, CI = 1.3, 2.9). Factors independently associated with recurrent otitis were any allergic condition (OR = 1. 9, CI = 1.7, 2.2); survey year (OR = 1.7, CI = 1.5, 1.9); Black race (OR = .6, CI = .5, .7); Hispanic ethnicity (OR = .8, CI = .6, .9); day care (OR = 1.5, CI = 1.3, 1.7); out-of-home care by an unrelated sitter (OR = 1.3, CI = 1.1, 1.6); and male gender (OR = 1.2, CI = 1. 1, 1.3). From 1981 to 1988, there were significant increases in some risk factors associated with recurrent otitis media, including day care (11% vs 21%) and allergic conditions (14% vs 18%).
  
  
  CONCLUSIONS
  We conclude that there has been a significant increase in the prevalence of recurrent otitis media among children in the United States, particularly in infants. The increased prevalence of recurrent otitis media was associated with an increase in the use of child care and a higher prevalence of allergic conditions among children.
authors.affiliation: Departments of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
authors.forename: B P
authors.initials: BP
authors.lastname: Lanphear
authors.forename: R S
authors.initials: RS
authors.lastname: Byrd
authors.forename: P
authors.initials: P
authors.lastname: Auinger
authors.forename: C B
authors.initials: CB
authors.lastname: Hall
mesh_terms: D002656:Child Day Care Centers; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D006967:Hypersensitivity / Q000150:complications / Q000453:epidemiology; D007223:Infant; D016015:Logistic Models; D008297:Male; D008876:Middle Ear Ventilation / Q000706:statistics & numerical data / Q000639:trends; D010033:Otitis Media / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D015995:Prevalence; D012008:Recurrence; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology