Living with Atopic Dermatitis as a Young Adult in Relation to Health-related Quality of Life and Healthcare Contacts: A Population-based Study
Keywords:Atopic dermatitis, Disease burden, Eczema, Epidemiology, Health-related quality of life
Most studies of health-related quality of life (HRQoL) and atopic dermatitis are based on data from dermatology clinics. The aim of this study was to determine whether atopic dermatitis affects HRQoL in adolescence and young adulthood, based on data from the population-based cohort BAMSE (Children, Allergy, Environmental, Stockholm, Epidemiology). A further aim was to determine if the use of topical corticosteroids and healthcare contacts affect HRQoL. Participants with data from birth to young adulthood (n=3,064) were included. Two generic instruments were used to measure HRQoL:General Health at age 12, 16 and 24 years and EQ-5D-3L, including EQ-visual analogue scale (EQ-VAS) at age 24 years. In addition, the disease-specific Dermatology Quality Life Index (DLQI) was used at 24 years. Healthcare consultations for atopic dermatitis were obtained from Stockholm Regional Healthcare Data Warehouse (n = 1,944). Participants with atopic dermatitis had an increased odds ratio (OR) of not feeling completely healthy (adjusted OR 1.50; 95% confidence interval (95% CI): 1.30–1.73). Participants with persistent atopic dermatitis, fulfilling atopic dermatitis criteria in the 12- and/or 16- and 24-year follow-ups reported worse EQ-VAS value 70.0 (95% CI 67.3–72.7) in the 25th percentile, than peers without atopic dermatitis. Over an 8-year period, contact with healthcare was limited (mean number 0.96). In conclusion, atopic dermatitis had a negative impact on HRQoL in young adults from adolescence to adulthood and healthcare consultations were few.
Irvine AD, Mina-Osorio P. Disease trajectories in childhood atopic dermatitis: an update and practitioner's guide. Br J Dermatol 2019; 181: 895-906.
Abuabara K, Yu AM, Okhovat JP, Allen IE, Langan SM. The prevalence of atopic dermatitis beyond childhood: a systematic review and meta-analysis of longitudinal studies. Allergy 2018; 73: 696-704.
Weidinger S, Novak N. Atopic dermatitis. Lancet 2016; 387: 1109-1122.
Ballardini N, Kull I, Soderhall C, Lilja G, Wickman M, Wahlgren CF. Eczema severity in preadolescent children and its relation to sex, filaggrin mutations, asthma, rhinitis, aggravating factors and topical treatment: a report from the BAMSE birth cohort. Br J Dermatol 2013; 168: 588-594.
Mortz CG, Andersen KE, Dellgren C, Barington T, Bindslev-Jensen C. Atopic dermatitis from adolescence to adulthood in the TOACS cohort: prevalence, persistence and comorbidities. Allergy 2015; 70: 836-845.
Balieva FN, Finlay AY, Kupfer J, Aragones LT, Lien L, Gieler U, et al. The role of therapy in impairing quality of life in dermatological patients: a multinational study. Acta Derm Venereol 2018; 98: 563-569.
Santer M, Burgess H, Yardley L, Ersser SJ, Lewis-Jones S, Muller I, et al. Managing childhood eczema: qualitative study exploring carers' experiences of barriers and facilitators to treatment adherence. J Adv Nurs 2013; 69: 2493-2501.
van Zuuren EJ, Fedorowicz Z, Arents BWM. Emollients and moisturizers for eczema: abridged Cochrane systematic review including GRADE assessments. Br J Dermatol 2017; 177: 1256-1271.
Wollenberg A, Barbarot S, Bieber T, Christen-Zaech S, Deleuran M, Fink-Wagner A, et al. Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I. J Eur Acad Dermatol Venereol 2018; 32: 657-682.
Lundin S, Wahlgren CF, Bergstrom A, Johansson EK, Dahlen E, Andersson N, et al. Use of emollients and topical glucocorticoids among adolescents with eczema - datafrom the population-based birth cohort BAMSE. Br J Dermatol 2018; 179: 709-716.
de Lusignan S, Alexander H, Broderick C, Dennis J, McGovern A, Feeney C, et al. Patterns and trends in eczema management in UK primary care (2009-2018): A population-based cohort study. Clin Exp Allergy 2021; 51: 483-494.
Singh P, Silverberg JI. Outpatient utilization patterns for atopic dermatitis in the United States. J Am Acad Dermatol 2019; 19: 30435-30439.
Lundin S, Jonsson M, Wahlgren CF, Johansson E, Bergstrom A, Kull I. Young adults' perceptions of living with atopic dermatitis in relation to the concept of self-management: a qualitative study. BMJ Open 2021; 11: e044777.
Eckert L, Gupta S, Gadkari A, Mahajan P, Gelfand JM. Burden of illness in adults with atopic dermatitis: analysis of National Health and Wellness Survey data from France, Germany, Italy, Spain, and the United Kingdom. J Am Acad Dermatol 2019; 81: 187-195.
Beattie PE, Lewis-Jones MS. A comparative study of impairment of quality of life in children with skin disease and children with other chronic childhood diseases. Br J Dermatol 2006; 155: 145-151.
Ring J, Zink A, Arents BWM, Seitz IA, Mensing U, Schielein MC, et al. Atopic eczema: burden of disease and individual suffering - results from a large EU study in adults. J Eur Acad Dermatol Venereol 2019; 33: 1331-1340.
Hebert AA, Stingl G, Ho LK, Lynde C, Cappelleri JC, Tallman AM, et al. Patient impact and economic burden of mild-to-moderate atopic dermatitis. Curr Med Res Opin 2018; 34: 2177-2185.
Birdi G, Cooke R, Knibb RC. Impact of atopic dermatitis on quality of life in adults: a systematic review and meta-analysis. Int J Dermatol 2020; 59: e75-e91.
Drucker AM, Wang AR, Li WQ, Sevetson E, Block JK, Qureshi AA. The burden of atopic dermatitis: summary of a report for the National Eczema Association. J Invest Dermatol 2016; 137: 26-30.
Wickman M, Kull I, Pershagen G, Nordvall SL. The BAMSE project: presentation of a prospective longitudinal birth cohort study. Pediatr Allergy Immunol 2002; 13: 11-13.
Melén E, Bergström A, Kull I, Almqvist C, Andersson N, Asarnoj A, et al. Male sex is strongly associated with IgE-sensitization to airborne but not food allergens: results up to age 24 years from the BAMSE birth cohort. Clin Transl Allergy 2020; 10: s13601-13020-00319-w.
Williams HC. Diagnostic criteria for atopic dermatitis. Lancet 1996; 348: 1391-1392.
Williams HC, Burney PG, Pembroke AC, Hay RJ. Validation of the U.K. diagnostic criteria for atopic dermatitis in a population setting. U.K. Diagnostic Criteria for Atopic Dermatitis Working Party. Br J Dermatol 1996; 135: 12-17.
Charman CR, Venn AJ, Williams HC. The patient-oriented eczema measure: development and initial validation of a new tool for measuring atopic eczema severity from the patients' perspective. Arch Dermatol 2004; 140: 1513-1519.
Lundberg O, Manderbacka K. Assessing reliability of a measure of self-rated health. Scand J Soc Med 1996; 24: 218-224.
EQ-5D-3L User Guide, 2018. [Accessed 2021-06-15] Available from: https://euroqol.org/publications/user-guides.
Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI) - a simple practical measure for routine clinical use. Clin Exp Dermatol 1994; 19: 210-216.
Carlsson AC, Wändell P, Ösby U, Zarrinkoub R, Wettermark B, Ljunggren G. High prevalence of diagnosis of diabetes, depression, anxiety, hypertension, asthma and COPD in the total population of Stockholm, Sweden - a challenge for public health. BMC Public Health 2013; 13: 670.
Fitzmaurice GM, Laird NM, Ware JH. Applied longitudinal analysis. Hoboken, NJ: John Wiley & Sons, Inc.; 2004.
Baćak V, Ólafsdóttir S. Gender and validity of self-rated health in nineteen European countries. Scand J Public Health 2017; 45: 647-653.
Macias C, Gold PB, Öngür D, Cohen BM, Panch T. Are single-item global ratings useful for assessing health status? J Clin Psychol Med Settings 2015; 22: 251-264.
Simpson EL, Guttman-Yassky E, Margolis DJ, Feldman SR, Qureshi A, Hata T, et al. Association of inadequately controlled disease and disease severity with patient-reported disease burden in adults with atopic dermatitis. JAMA Dermatol 2018; 154: 903-912.
Huet F, Shourick J, Séité S, Taïeb C, Misery L. Pain in atopic dermatitis: an online population-based survey. Acta Derm Venereol 2020; 100: adv00198.
Vakharia PP, Chopra R, Sacotte R, Patel KR, Singam V, Patel N, et al. Burden of skin pain in atopic dermatitis. Ann Allergy Asthma Immunol 2017; 119: 548-552.e543.
Hon KL, Pong NH, Poon TC, Chan DF, Leung TF, Lai KY, et al. Quality of life and psychosocial issues are important outcome measures in eczema treatment. J Dermatolog Treat 2015; 26: 83-89.
Schonmann Y, Mansfield KE, Hayes JF, Abuabara K, Roberts A, Smeeth L, et al. Atopic eczema in adulthood and risk of depression and anxiety: a population-based cohort study. J Allergy Clin Immunol Pract 2020; 8: 248-257.e216.
Moberg C, Alderling M, Meding B. Hand eczema and quality of life: a population-based study. Br J Dermatol 2009; 161: 397-403.
Hsieh BJ, Shen D, Hsu CJ, Chan TC, Cho YT, Tang CH, et al. The impact of atopic dermatitis on health-related quality of life in Taiwan. J Formos Med Assoc 2021; 121: 269-277.
Basra MK, Salek MS, Camilleri L, Sturkey R, Finlay AY. Determining the minimal clinically important difference and responsiveness of the Dermatology Life Quality Index (DLQI): further data. Dermatology 2015; 230: 27-33.
Ghio D, Muller I, Greenwell K, Roberts A, McNiven A, Langan SM, et al. 'It's like the bad guy in a movie who just doesn't die': a qualitative exploration of young people's adaptation to eczema and implications for self-care. Br J Dermatol 2020; 182: 112-118.
Wändell P, Carlsson AC, Wettermark B, Lord G, Cars T, Ljunggren G. Most common diseases diagnosed in primary care in Stockholm, Sweden, in 2011. Fam Pract 2013; 30: 506-513.
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Copyright (c) 2022 Susanne Lundin, Anna Bergström, Carl-Fredrik Wahlgren, Emma K. Johansson, Niklas Andersson, Natalia Ballardini, Marina Jonsson, Erik Melén, Inger Kull
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