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Atopic dermatitis (AD) poses a significant public health burden owing to its high prevalence, considerable morbidity, increased health care utilization, and cost of care.
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AD may be more common in adults than previously recognized, secondary to both persistence of childhood disease and adult-onset disease.
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The prevalence of childhood atopic dermatitis dramatically increased in the United States and internationally over the past few years.
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Recent studies suggest that atopic dermatitis is more common
Public Health Burden and Epidemiology of Atopic Dermatitis
Section snippets
Key points
Challenges of studying the epidemiology of atopic dermatitis
There are several challenges of studying the epidemiology of AD. First, there are no widely accepted biomarkers or objective diagnostic tests for AD. Moreover, the lack of standardized nomenclature for AD internationally, for example, atopic neurodermatitis, eczema, atopic eczema, and childhood eczema, makes it difficult to develop consistent and valid questionnaires for epidemiology research. In particular, the term, eczema, has several different uses, including as the most commonly used lay
United States
Recent prevalence estimates of childhood AD in the United States range from 6% to 12.98%, depending on the study design and approach used to assess for AD. A household survey of 42,249 children and adults in 1998 found that 10.7% had empirically defined eczema, and 6% had empirically defined AD.2 This study did not distinguish, however, between AD in children and adults. Household surveys of 102,353 and 91,642 children ages 0 to 17 from the 2003–2004 National Survey of Children’s Health (NSCH)
Epidemiology of adult atopic dermatitis
The conventional dogma has been that AD is a disorder of childhood, with few adults having active disease. Several recent studies suggest, however, that AD may be more common in adults than previously recognized. International studies of AD in adults found prevalence ranging from 2.0% to 6.9% prior to 2000 depending on regional and methodological differences.26, 27, 28, 29, 30 Recent studies, however, of 27,157 and 34,613 adults (ages 18–85 years) from the 2010 NHIS and 2012 NHIS found 1-year
Atopic dermatitis severity
AD severity assessments reflect a combination of symptoms (eg, itch and sleep disturbance), lesional severity (redness, thickness, lichenification, scaling, and so forth), and/or the extent of disease. Recent international consensus was achieved for the objective assessment of AD severity, with the Eczema Area and Severity Index and Scoring Atopic Dermatitis emerging as preferred assessments.36 Although these assessments are routinely used in clinical trials or smaller-scale studies, they are
Cost of atopic dermatitis
Although AD is typically nonfatal, there is substantial disease-related morbidity and disability. The 2010 Global Burden of Disease survey found that AD had the highest disability-adjusted life-years among skin disorders, which reflects both the high prevalence and patient burden.42, 43 The payer costs for AD vary by region and different health care delivery systems.44, 45 There are no recent estimates of the costs of AD in the United States. However, 2 older studies published in 1993 and 2002
Summary
In conclusion, AD poses a considerable public health burden owing to its high prevalence in both children and adults, high proportion of patients with moderate and severe disease, disease-related disability, and higher direct and indirect costs to payers and patients alike. Future research is needed to identify population-based risk factors and opportunities for disease prevention.
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