Temporal changes in UK birth order and the prevalence of atopy.
BACKGROUND
Many studies have reported an inverse association between birth order and the risk of respiratory allergic disease. In recent decades, the prevalence of atopy has increased alongside reductions in fertility rates.


OBJECTIVE
To quantitate how much of the increased prevalence of atopy, measured by skin prick test or specific IgE, can be attributed to temporal changes in family size in the United Kingdom.


METHODS
Through a systematic literature review (MEDLINE, 1965-2009), five studies of UK populations were identified and their data were included in the calculation of a summary odds ratio for the risk of atopy for each birth order. Information on changes in UK family sizes between 1960 and 2001 was obtained from Eurostat. On this basis, expected increases in the prevalence of atopy were calculated by weighting the proportion in each birth order category for 1960 and 2001 by the summary odds ratio for that category and then calculating the relative risk of atopy in 2001 compared with 1960.


RESULTS
The pooled summary odds ratios for atopy were 0.90, 0.69 and 0.69 for those born second, third and fourth (or higher), respectively. The expected relative increase in the prevalence of atopy resulting from a change in family size between 1960 and 2001 was 3%.


CONCLUSIONS
Despite the strong associations between birth order and atopy, reductions in family size in the last 40 years account for little of the increase in atopy.
Occupational & Environmental Medicine, Imperial College School of Medicine (NHLI), London, UK. s.upchurch@imperial.ac.uk
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Upchurch
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Harris
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Cullinan
D000328:Adult; D001722:Birth Order; D016022:Case-Control Studies; D002648:Child; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000453:epidemiology*; D007073:Immunoglobulin E / Q000097:blood; D008875:Middle Aged; D015995:Prevalence; D012882:Skin Tests; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
D007073:Immunoglobulin E