title: Chronic suppurative otitis media in a birth cohort of children in Greenland: population-based study of incidence and risk factors.
abstract: BACKGROUND
  Inuits of the Arctic experience very high rates of chronic suppurative otitis media (CSOM), yet world-wide, very little is known about the epidemiology of CSOM. The study aims were to determine incidence, median age at debut, risk factors, and associated population attributable risks for CSOM in young children in Sisimiut, the second biggest town of Greenland (population 5400), where living conditions are relatively western and approximately 90% are Inuits.
  
  
  METHODS
  A population-based birth cohort of 465 children aged between 0 and 4 years was followed for a 2-year period (1996 to 1998), and cases of CSOM were registered based on medical history and clinical examinations. Kaplan-Meier curves were used for estimations of cumulative risk and Cox regression analyses for hazard rates associated with risk factors.
  
  
  RESULTS
  Cumulative risk of CSOM at 4 years of age was 14%, and median age at debut was 336 days. Risk factors were attending childcare centers (hazard ratio [HR]: 3.18, 95% confidence interval [CI]: 1.53- 6.61), having smokers in the household (HR: 4.56, 95% CI: 1.07-19.4), having a mother who reported a history of purulent ear discharge (3.27, 95% CI: 1.74-6.13), having a high burden of upper respiratory tract infections (HR: 1.19, 95% CI: 1.03-1.37), and being Inuit (HR: 5.56, 95% CI: 0.78-50).
  
  
  CONCLUSIONS
  Greenlandic children have high rates of CSOM with debut early in life, but the identified risk factors and the associated population attributable risks indicate that preventive measures regarding use of childcare centers and passive smoking may reduce the high frequency of CSOM in this high-risk population.
authors.affiliation: Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark. ako@ssi.dk
authors.forename: Anders
authors.initials: A
authors.lastname: Koch
authors.forename: Preben
authors.initials: P
authors.lastname: Homøe
authors.forename: Christian
authors.initials: C
authors.lastname: Pipper
authors.forename: Thomas
authors.initials: T
authors.lastname: Hjuler
authors.forename: Mads
authors.initials: M
authors.lastname: Melbye
mesh_terms: D002675:Child, Preschool; D002908:Chronic Disease / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006116:Greenland / Q000453:epidemiology; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D010035:Otitis Media, Suppurative / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012307:Risk Factors