Risk factors for otitis media: an international perspective.
BACKGROUND
Opinions about otitis media (OM) as an illness and about the need for antibiotic or surgical treatment vary internationally. It is not known how this is to be explained, whether by cultural differences or by other factors, such as variation in environmental risk factors for OM.


OBJECTIVE
To report on variation in environmental risk factors for OM across Western countries, and on the organisation of health care in these countries.


METHODS
Main environmental risk factors for OM were identified by searching Pubmed. Data on the distribution of these risk factors and the organisation of health care across countries were obtained from the OECD and WHO websites.


RESULTS
Main risk factors for OM were day-care, number of siblings, smoking, breastfeeding, birth weight, socio-economic status (SES) and air pollution. Data were available for several European countries, the United State, Canada and Australia. Large international differences were found regarding the proportion of children attending day-care (Sweden 75% versus Italy 6%) and being breastfed at age 6 months (Norway 80% versus Poland 6%), and the rate of female smokers (Germany, France and Norway 30-40% versus Portugal <10%).


CONCLUSIONS
It appears that differences in risk factor exposure between populations are often overshadowed by other culturally or demographically significant factors. Attempts to discern these factors within populations and between countries may be important in the management of OM and warrants further study.
Rovers
Maroeska M
MM
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Stratenum 6.139, P.O. Box 85060, 3508 AB Utrecht, The Netherlands. M.Rovers@umcutrecht.nl
de Kok
Inge M C M
IM
Schilder
Anne G M
AG
D000397:Air Pollution / Q000706:statistics & numerical data; D001315:Australia / Q000453:epidemiology; D001724:Birth Weight; D001942:Breast Feeding / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D002656:Child Day Care Centers / Q000706:statistics & numerical data; D002675:Child, Preschool; D003469:Culture; D005060:Europe / Q000453:epidemiology; D014943:Global Health; D006801:Humans; D015994:Incidence; D007223:Infant; D010033:Otitis Media / Q000453:epidemiology*; D010036:Otolaryngology / Q000706:statistics & numerical data*; D012307:Risk Factors; D035781:Siblings; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology