Childhood eczema: disease of the advantaged?

To determine whether the increased prevalence of childhood eczema in advantaged socioeconomic groups is due to increased parental reporting.

Comparison of parental reports of eczema with visible eczema recorded by medical officers during a detailed physical examination.

National birth cohort study.

8279 children from England, Wales, and Scotland born during 3-9 March 1958 and followed up at the ages of 7, 11, and 16.

Prevalence of eczema according to parental report compared with medical officer's examination at the ages of 7, 11, and 16.

Prevalence of both reported and examined eczema increased with rising social class at the ages of 7, 11, and 16 years. The point prevalence of examined eczema at age 7 was 4.8%, 3.6%, 3.6%, 2.4%, 2.2%, and 2.4% in social classes I, II, III non-manual, III manual, IV, and V respectively (chi 2 value for linear trend 12.6, P < 0.001). This trend persisted after adjustment for potential confounders such as region and family size and was not present for examined psoriasis or acne.

Eczema is more prevalent among British schoolchildren in social classes I and II than those in lower classes. Exposures associated with social class are probably at least as important as genetic factors in the expression of childhood eczema.