Chest
Volume 115, Issue 4, April 1999, Pages 928-936
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Clinical investigations
Asthma
Incidence and Prevalence of Asthma Among Adult Finnish Men and Women of the Finnish Twin Cohort From 1975 to 1990, and Their Relation to Hay Fever and Chronic Bronchitis

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Study objectives

To examine the prevalence of asthma and hay fever, and the incidence and temporal relationships of asthma, hay fever, and chronic bronchitis among adult twins during a 15-year period.

Participants

A population of 11,540 Finnish adult men and women, initially 18 to 45 years of age, who returned a health questionnaire in 1975, 1981, and 1990 as part of the Finnish Twin Cohort study.

Methods

Age-standardized prevalences and cumulative incidences among individuals were calculated for asthma, hay fever, and chronic bronchitis. The incidence of asthma among subjects with and without hay fever or chronic bronchitis was analyzed in the entire cohort as well as in twin pairs discordant for incident asthma.

Results

The prevalence of asthma increased slightly from 1975 (2.0% in men and 2.2% in women) to 1990 (2.9% in men and 3.1% in women). The prevalence of hay fever showed a larger increase in men and women (from 6.8% and 9.8% to 11.8% and 15.3%, respectively). Compared with figures for 1976 to 1981, no significant increase in asthma incidence occurred from 1982 to 1990, whereas the incidence of hay fever was lower during the latter period among men (incidence rate ratio, 0.7; 95% confidence interval, 0.6 to 0.9) as was the incidence of chronic bronchitis among women (incidence rate ratio, 0.7; 95% confidence interval, 0.6 to 0.9). Hay fever and chronic bronchitis were usually diagnosed before asthma. Both diseases increased the risk of asthma significantly on the basis of analyses of all individuals and of discordant twin pairs.

Conclusions

The pattern of increase in asthma and hay fever prevalence with time was similar, and hay fever was a strong predictor of asthma. These diseases showed no significant increase in incidence.

Section snippets

Study Population

The study population was based on the Finnish Twin Cohort, which consists primarily of adult twin pairs with both members born before 1958 and alive in 1967. Pairs of individuals with the same birth date and sex, as well as the same surname and local community at birth, were identified from the Central Population Registry of Finland.19 These selection criteria also captured a small number of unrelated individuals. A postal questionnaire was sent to cohort members in the autumn of 1975 (response

Results

The three questionnaires permitted assessment of stability of response to the disease questions. Of those reporting asthma in 1975, 10 of 53 men (19%) and 9 of 50 women (18%) no longer reported it either in 1981 or in 1990. Furthermore, 13 of 53 men (25%) and 6 of 50 women (12%) reported asthma only in one of the later questionnaires. Among those subjects not reporting asthma in 1975, 11 of 29 men (38%) and 22 of 53 women (42%) who reported asthma in 1981 no longer reported it in 1990; among

Discussion

Because our study population consisted of young and middle-aged adults who were all ≤ 60 years at the end of the follow-up, we avoided most diagnostic problems common among the elderly. Subjects reporting the study diseases in the first questionnaire in 1975 were excluded from the incidence analyses. It is possible that some of the diseases diagnosed in childhood were not reported in 1975 because they were in remission or forgotten. As Grol et al26 have recently concluded, disappearance of

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    The work was performed at the Department of Public Health, Universityof Helsinki. Supported by the Finnish Anti-Tuberculosis Association Foundation, the Ida Montin Foundation, the Finnish Foundation for Allergy Research, and the Academy of Finland (grants 38332, 42044).

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