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Original article
Gender differences in prevalence, diagnosis and incidence of allergic and non-allergic asthma: a population-based cohort
  1. Bénédicte Leynaert1,2,3,
  2. Jordi Sunyer4,5,6,7,
  3. Raquel Garcia-Esteban4,5,7,
  4. Cecilie Svanes8,9,
  5. Deborah Jarvis10,
  6. Isa Cerveri11,
  7. Julia Dratva12,13,
  8. Thorarinn Gislason14,
  9. Joachim Heinrich15,
  10. Christer Janson16,
  11. Nino Kuenzli12,13,
  12. Roberto de Marco17,
  13. Ernst Omenaas8,18,
  14. Chantal Raherison19,
  15. Francisco Gómez Real8,20,
  16. Matthias Wjst21,22,
  17. Elisabeth Zemp12,13,
  18. Mahmoud Zureik1,2,
  19. Peter G J Burney10,
  20. Josep M Anto4,5,6,7,
  21. Françoise Neukirch1,2
  1. 1Inserm, Unit 700, Team of Epidemiology, Paris, France
  2. 2Université Paris-Diderot Paris 7, Paris, France
  3. 3Centre d'Investigation Clinique, Hôpital Bichat, Paris, France
  4. 4Centre for Research on Environmental Epidemiology, CREAL, Barcelona, Spain
  5. 5Municipal Institute of Medical Research, IMIM, Barcelona, Spain
  6. 6Universitat Pompeu Fabra, Barcelona, Spain
  7. 7CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
  8. 8Bergen Respiratory Research Group, Institute of Medicine, University of Bergen, Bergen, Norway
  9. 9Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
  10. 10National Heart and Lung Institute, Imperial College London, London, UK
  11. 11Division of Respiratory Diseases, Fondazione IRCCS, University of Pavia, Pavia, Italy
  12. 12Swiss Tropical and Public Health Institute (SwissTPH), Basel, Switzerland
  13. 13University of Basel, Basel, Switzerland
  14. 14Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
  15. 15Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology, Munich, Germany
  16. 16Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden
  17. 17Department of Medicine and Public Health, University of Verona, Verona, Italy
  18. 18Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
  19. 19ISPED U897, Université Bordeaux Segalen, Bordeaux, France
  20. 20Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
  21. 21Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Lung Biology and Disease, Munich, Germany
  22. 22Institute of Genetic Medicine, EURAC Research, Bozen, Italy
  1. Correspondence to Bénédicte Leynaert, INSERM Unité 700, Epidémiologie – Faculté de Médecine X, Bichat, 16 Rue Henri Huchard, Paris 75018, France; benedicte.leynaert{at}


Background Although women with severe non-allergic asthma may represent a substantial proportion of adults with asthma in clinical practice, gender differences in the incidence of allergic and non-allergic asthma have been little investigated in the general population.

Methods Gender differences in asthma prevalence, reported diagnosis and incidence were investigated in 9091 men and women randomly selected from the general population and followed up after 8–10 years as part of the European Community Respiratory Health Survey. The protocol included assessment of bronchial responsiveness, IgE specific to four common allergens and skin tests to nine allergens.

Results Asthma was 20% more frequent in women than in men over the age of 35 years. Possible under-diagnosis of asthma appeared to be particularly frequent among non-atopic individuals, but was as frequent in women as in men. The follow-up of subjects without asthma at baseline showed a higher incidence of asthma in women than in men (HR 1.94; 95% CI 1.40 to 2.68), which was not explained by differences in smoking, obesity or lung function. More than 60% of women and 30% of men with new-onset asthma were non-atopic. The incidence of non-allergic asthma was higher in women than in men throughout all the reproductive years (HR 3.51; 95% CI 2.21 to 5.58), whereas no gender difference was observed for the incidence of allergic asthma.

Conclusions This study shows that female sex is an independent risk factor for non-allergic asthma, and stresses the need for more careful assessment of possible non-allergic asthma in clinical practice, in men and women.

  • Sex
  • asthma
  • atopy
  • diagnosis

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  • Funding Several parties funded the study data collection. The complete list of funders is provided in the online supplement.

  • Competing interests None.

  • Patient consent The article does not contain personal medical information about identifiable subjects.

  • Ethics approval Local ethics committees and institutional review boards.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Researchers who wish to run analysis using the ECRHS data are invited to contact the coordinating centre in London. See the ECRHS website