title: Global Associations between UVR Exposure and Current Eczema Prevalence in Children from ISAAC Phase Three.
abstract: We sought to examine the relationship globally between UVR dose exposure and current eczema prevalences. ISAAC Phase Three provided data on eczema prevalence for 13- to 14-year-olds in 214 centers in 87 countries and for 6- to 7-year-olds in 132 centers in 57 countries. Linear and nonlinear associations between (natural log transformed) eczema prevalence and the mean, maximum, minimum, standard deviation, and range of monthly UV dose exposures were assessed using linear mixed-effects regression models. For the 13- to 14-year-olds, the country-level eczema prevalence was positively and linearly associated with country-level monthly mean (prevalence ratio = 1.31 [95% confidence interval = 1.05-1.63] per kJ/m2) and minimum (1.25 [1.06-1.47] per kJ/m2) UVR dose exposure. Linear and nonlinear associations were also observed for other metrics of UV. Results were similar in trend, but nonsignificant, for the fewer centers with 6- to 7-year-olds (e.g., 1.24 [0.96-1.59] per kJ/m2for country-level monthly mean UVR). No consistent within-country associations were observed (e.g., 1.05 [0.89-1.23] and 0.92 [0.71-1.18] per kJ/m2for center-level monthly mean UVR for the 13- to 14- and 6- to 7-year-olds, respectively). These ecological results support a role for UVR exposure in explaining some of the variation in global childhood eczema prevalence.
authors.affiliation: ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain. Electronic address: elaine.fuertes@isglobal.org.
authors.forename: Elaine
authors.initials: E
authors.lastname: Fuertes
authors.affiliation: Unit for Population-Based Dermatology Research, St. John's Institute of Dermatology, King's College London and Guy's & St. Thomas' NHS Foundation Trust, London, UK.
authors.forename: Carsten
authors.initials: C
authors.lastname: Flohr
authors.affiliation: Departments of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Northwestern Medicine Multidisciplinary Eczema Centre, Chicago, Illinois, USA.
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Silverberg
authors.affiliation: Institute of Epidemiology I, Helmholtz Zentrum München-German Research Centre for Environmental Health, Neuherberg, Germany.
authors.forename: Marie
authors.initials: M
authors.lastname: Standl
authors.affiliation: Population Health Research Institute, St. George's, University of London, London, UK.
authors.forename: David P
authors.initials: DP
authors.lastname: Strachan
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D004485:Eczema / Q000175:diagnosis* / Q000453:epidemiology*; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D014943:Global Health; D006306:Health Surveys; D006801:Humans; D038622:Internationality; D016014:Linear Models; D008297:Male; D015995:Prevalence; D012720:Severity of Illness Index; D017678:Sex Distribution; D013997:Time Factors; D014466:Ultraviolet Rays / Q000009:adverse effects*