Elsevier

Dermatologic Clinics

Volume 35, Issue 3, July 2017, Pages 283-289
Dermatologic Clinics

Public Health Burden and Epidemiology of Atopic Dermatitis

https://doi.org/10.1016/j.det.2017.02.002Get rights and content

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Key points

  • Atopic dermatitis (AD) poses a significant public health burden owing to its high prevalence, considerable morbidity, increased health care utilization, and cost of care.

  • AD may be more common in adults than previously recognized, secondary to both persistence of childhood disease and adult-onset disease.

  • The prevalence of childhood atopic dermatitis dramatically increased in the United States and internationally over the past few years.

  • Recent studies suggest that atopic dermatitis is more common

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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References (70)

  • C.J. Murray et al.

    Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010

    Lancet

    (2012)
  • T. Vos et al.

    Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010

    Lancet

    (2012)
  • C.N. Ellis et al.

    Cost of atopic dermatitis and eczema in the United States

    J Am Acad Dermatol

    (2002)
  • C.S. Lapidus et al.

    Atopic dermatitis in children: who cares? Who pays?

    J Am Acad Dermatol

    (1993)
  • A.B. Fishbein et al.

    Nocturnal eczema: review of sleep and circadian rhythms in children with atopic dermatitis and future research directions

    J Allergy Clin Immunol

    (2015)
  • S.H. Yu et al.

    Association between atopic dermatitis and depression in US Adults

    J Invest Dermatol

    (2015)
  • N. Garg et al.

    Association between childhood allergic disease, psychological comorbidity, and injury requiring medical attention

    Ann Allergy Asthma Immunol

    (2014)
  • M.A. Strom et al.

    Associations of physical activity and sedentary behavior with atopic disease in United States children

    J Pediatr

    (2016)
  • J.I. Silverberg et al.

    Childhood atopic dermatitis and warts are associated with increased risk of infection: a US population-based study

    J Allergy Clin Immunol

    (2014)
  • P. Yaghmaie et al.

    Mental health comorbidity in patients with atopic dermatitis

    J Allergy Clin Immunol

    (2013)
  • N.K. Garg et al.

    Eczema is associated with osteoporosis and fractures in adults: a US population-based study

    J Allergy Clin Immunol

    (2015)
  • J.I. Silverberg et al.

    Eczema and cardiovascular risk factors in 2 US adult population studies

    J Allergy Clin Immunol

    (2015)
  • J.I. Silverberg et al.

    Association between obesity and atopic dermatitis in childhood: a case-control study

    J Allergy Clin Immunol

    (2011)
  • A. Zhang et al.

    Association of atopic dermatitis with overweight and obesity: a systematic review and meta-analysis

    J Am Acad Dermatol

    (2015)
  • M.G. Filanovsky et al.

    The financial and emotional impact of atopic dermatitis on children and their families

    J Pediatr

    (2016)
  • R. Kantor et al.

    Atopic dermatitis, atopic eczema, or eczema? A systematic review, meta-analysis, and recommendation for uniform use of 'atopic dermatitis'

    Allergy

    (2016)
  • J.M. Hanifin et al.

    A population-based survey of eczema prevalence in the United States

    Dermatitis

    (2007)
  • J.I. Silverberg et al.

    Association between severe eczema in children and multiple comorbid conditions and increased healthcare utilization

    Pediatr Allergy Immunol

    (2013)
  • J.I. Silverberg et al.

    Assessment of atopic dermatitis using self-report and caregiver report: a multicentre validation study

    Br J Dermatol

    (2015)
  • J.I. Silverberg et al.

    Associations of childhood eczema severity: a US population-based study

    Dermatitis

    (2014)
  • D.J. Purvis et al.

    Risk factors for atopic dermatitis in New Zealand children at 3.5 years of age

    Br J Dermatol

    (2005)
  • Y.K. Tay et al.

    The prevalence and descriptive epidemiology of atopic dermatitis in Singapore school children

    Br J Dermatol

    (2002)
  • P.E. Martin et al.

    The prevalence and socio-demographic risk factors of clinical eczema in infancy: a population-based observational study

    Clin Exp Allergy

    (2013)
  • F. Xu et al.

    Prevalence of childhood atopic dermatitis: an urban and rural community-based study in Shanghai, China

    PLoS One

    (2012)
  • Y. Belyhun et al.

    Prevalence and risk factors of wheeze and eczema in 1-year-old children: the Butajira birth cohort, Ethiopia

    Clin Exp Allergy

    (2010)
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