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Comorbidities in childhood atopic dermatitis : A population-based study

von Kobyletzki, Laura LU ; Henrohn, Dan ; Ballardini, Natalia ; Neary, Maureen P. ; Ortsäter, Gustaf ; Rieem Dun, Alexander ; Geale, Kirk ; Lindberg, Ingrid ; Theodosiou, Grigorios LU orcid and Neregård, Petra , et al. (2023) In Journal of the European Academy of Dermatology and Venereology
Abstract

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease that is associated with allergic comorbidities. However, studies examining comorbidities in childhood AD are incomplete, which may contribute to suboptimal care. Objective: The objective was to compare the risk of developing different allergic and non-allergic comorbidities among children with AD to that of a matched non-AD reference cohort in Sweden. Methods: This was a nationwide population-based cohort study using longitudinal data from primary and specialist care registers. Patients with AD were identified by confirmed diagnosis in primary or specialist care. The non-AD reference cohort was randomly drawn from the general population and matched 1:1 with the AD... (More)

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease that is associated with allergic comorbidities. However, studies examining comorbidities in childhood AD are incomplete, which may contribute to suboptimal care. Objective: The objective was to compare the risk of developing different allergic and non-allergic comorbidities among children with AD to that of a matched non-AD reference cohort in Sweden. Methods: This was a nationwide population-based cohort study using longitudinal data from primary and specialist care registers. Patients with AD were identified by confirmed diagnosis in primary or specialist care. The non-AD reference cohort was randomly drawn from the general population and matched 1:1 with the AD patients. The risk of developing the following conditions was evaluated: hypersensitivity and allergic disorders, neurological disorders, psychiatric disorders, infections, immunological and inflammatory disorders, Type 1 diabetes (T1D), endocrine and metabolic disorders, skeletal disorders, ocular disorders and malignancies. Results: This study included 165,145 patients with AD (mild-to-moderate [n = 126,681] and severe [n = 38,464]) and an equally sized reference cohort. Patients with AD displayed a higher risk of developing comorbid conditions for all investigated categories, except for T1D and skeletal disorders, compared with the reference cohort. The highest risk compared with the reference cohort was observed for hypersensitivity and allergic disorders (hazard ratio [HR]: 3.87), followed by malignancies (HR: 2.53) and immunological and inflammatory disorders (HR: 2.36). Patients with AD also had higher risk of developing multiple comorbidities (≥2). The risk of comorbidity onset increased alongside AD severity and patients with active AD were associated with increased risk of comorbidity onset compared with patients in remission. Conclusions: The clinical burden of AD is substantial for children with AD and patients are at an increased risk of developing several comorbid conditions extending beyond the atopic march. Our results also showed a positive association between worsening severity of AD and an increased risk of comorbidity onset.

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Contribution to journal
publication status
in press
subject
in
Journal of the European Academy of Dermatology and Venereology
publisher
Elsevier
external identifiers
  • pmid:37824103
  • scopus:85174597101
ISSN
0926-9959
DOI
10.1111/jdv.19569
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2023 The Authors. Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.
id
f62c8713-ceb8-4792-bdaf-05e8f92bb8bd
date added to LUP
2023-12-14 15:52:09
date last changed
2024-04-27 11:14:34
@article{f62c8713-ceb8-4792-bdaf-05e8f92bb8bd,
  abstract     = {{<p>Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease that is associated with allergic comorbidities. However, studies examining comorbidities in childhood AD are incomplete, which may contribute to suboptimal care. Objective: The objective was to compare the risk of developing different allergic and non-allergic comorbidities among children with AD to that of a matched non-AD reference cohort in Sweden. Methods: This was a nationwide population-based cohort study using longitudinal data from primary and specialist care registers. Patients with AD were identified by confirmed diagnosis in primary or specialist care. The non-AD reference cohort was randomly drawn from the general population and matched 1:1 with the AD patients. The risk of developing the following conditions was evaluated: hypersensitivity and allergic disorders, neurological disorders, psychiatric disorders, infections, immunological and inflammatory disorders, Type 1 diabetes (T1D), endocrine and metabolic disorders, skeletal disorders, ocular disorders and malignancies. Results: This study included 165,145 patients with AD (mild-to-moderate [n = 126,681] and severe [n = 38,464]) and an equally sized reference cohort. Patients with AD displayed a higher risk of developing comorbid conditions for all investigated categories, except for T1D and skeletal disorders, compared with the reference cohort. The highest risk compared with the reference cohort was observed for hypersensitivity and allergic disorders (hazard ratio [HR]: 3.87), followed by malignancies (HR: 2.53) and immunological and inflammatory disorders (HR: 2.36). Patients with AD also had higher risk of developing multiple comorbidities (≥2). The risk of comorbidity onset increased alongside AD severity and patients with active AD were associated with increased risk of comorbidity onset compared with patients in remission. Conclusions: The clinical burden of AD is substantial for children with AD and patients are at an increased risk of developing several comorbid conditions extending beyond the atopic march. Our results also showed a positive association between worsening severity of AD and an increased risk of comorbidity onset.</p>}},
  author       = {{von Kobyletzki, Laura and Henrohn, Dan and Ballardini, Natalia and Neary, Maureen P. and Ortsäter, Gustaf and Rieem Dun, Alexander and Geale, Kirk and Lindberg, Ingrid and Theodosiou, Grigorios and Neregård, Petra and De Geer, Anna and Cha, Amy and Cappelleri, Joseph C. and Thyssen, Jacob P.}},
  issn         = {{0926-9959}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Journal of the European Academy of Dermatology and Venereology}},
  title        = {{Comorbidities in childhood atopic dermatitis : A population-based study}},
  url          = {{http://dx.doi.org/10.1111/jdv.19569}},
  doi          = {{10.1111/jdv.19569}},
  year         = {{2023}},
}