Determinants of international variation in asthma and allergies in childhood: a multilevel approach

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Asthma and allergies pose a considerable burden on children and their families. The prevalence varies widely internationally from 20-fold to 60-fold for asthma and eczema, respectively. In many countries the disease frequency is still increasing. Prevalence is most likely linked to the prevailing living conditions which are subject to rapid change world wide. The influence of “western life style” and related individual risk factors is intensively discussed in the literature. However, we are still far from understanding the observed variation, and therefore the driving risk factors for disease occurrence. Instead of continuing to focus only on the role of individual risk factors we propose a more holistic and encompassing approach taking e.g. also into account that the influence of risk factors may vary considerably in different environmental or cultural settings. With risk factor information and objective markers collected with uniform methods in 30 centres from 22 countries worldwide, Phase Two of The International Study of Asthma and Allergies in Childhood (ISAAC) is uniquely placed to investigate international variation and their determinants. Advanced statistical approaches, in particular multilevel modelling will be used to determine the contribution of individual and contextual risk factors. Identification of influential determinants will provide invaluable guidance to develop effective prevention strategies to prevent any further rise in asthma and allergies world wide and may be even to reverse previous rises in nowadays high prevalence countries.