Abstract

BackgroundLimited evidence suggests increased fracture risk in people with atopic eczema. Any link could have substantial effect; atopic eczema is common, and fractures have associated morbidity and mortality.ObjectiveWe sought to examine whether atopic eczema is associated with fracture and whether fracture risk varies with eczema severity.MethodsWe performed a matched cohort study set in primary care (Clinical Practice Research Datalink GOLD 1998-2016) and linked hospital admissions data (Hospital Episode Statistics), including adults (≥18 years old) with atopic eczema matched (by age, sex, general practice, and cohort entry date) with up to 5 individuals without eczema. We estimated hazard ratios (HRs) from stratified Cox regression comparing risk of major osteoporotic (hip, pelvis, spine, wrist, and proximal humerus) fractures individually and any fracture in those with and without atopic eczema.ResultsWe identified 526,808 people with atopic eczema and 2,569,030 people without atopic eczema. Those with eczema had increased risk of hip (HR, 1.10; 99% CI, 1.06-1.14), pelvic (HR, 1.10; 99% CI, 1.02-1.19), spinal (HR, 1.18; 99% CI, 1.10-1.27), and wrist (HR, 1.07; 99% CI, 1.03,-1.11) fractures. We found no evidence of increased proximal humeral (HR, 1.06; 99% CI, 0.97-1.15) fracture risk. Fracture risk increased with increasing eczema severity, with the strongest associations in people with severe eczema (compared with those without) for spinal (HR, 2.09; 99% CI, 1.66-2.65), pelvic (HR, 1.66; 99% CI, 1.26-2.20), and hip (HR, 1.50; 99% CI, 1.30-1.74) fractures. Associations persisted after oral glucocorticoid adjustment.ConclusionsPeople with atopic eczema have increased fracture risk, particularly major osteoporotic fractures.

Highlights

  • Limited evidence suggests increased fracture risk in people with atopic eczema

  • We found no evidence of increased proximal humeral (HR, 1.06; 99% CI, 0.97-1.15) fracture risk

  • Fracture risk increased with increasing eczema severity, with the strongest associations in people with severe eczema for spinal (HR, 2.09; 99% CI, 1.66-2.65), pelvic (HR, 1.66; 99% CI, 1.26-2.20), and hip (HR, 1.50; 99% CI, 1.30-1.74) fractures

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Summary

Methods

We performed a matched cohort study set in primary care (Clinical Practice Research Datalink GOLD 1998-2016) and linked hospital admissions data (Hospital Episode Statistics), including adults (>_18 years old) with atopic eczema matched (by age, sex, general practice, and cohort entry date) with up to 5 individuals without eczema. We undertook a matched cohort study between January 2, 1998, and March 31, 2016, using routinely collected United Kingdom (UK) electronic health records data (primary care data from the Clinical Practice Research Datalink [CPRD Gold] and linked hospital admissions data from Hospital Episode Statistics [HES]). We identified a cohort of people with atopic eczema based on a previously validated algorithm[13] requiring a diagnostic code for eczema and at least 2 records for eczema therapy (see the Methods section in this article’s Online Repository). Where patient-level data were unavailable, we used practice-level data from England (because of the requirement for HES linkage, we used English data only) in 2010 (the closest available English practice-level data to 2007; ie, the version of patient-level data used)

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