Abstract
Lower socioeconomic position usually portends worse health outcomes, but multiple studies have found that atopic dermatitis is associated with higher socioeconomic position. The nature of this relationship remains unclear. To systematically review the literature on socioeconomic position and atopic dermatitis and determine whether the association varies by patient or study characteristics. A literature search was conducted in the PubMed and Embase databases. Individual-level studies addressing the association between all measures of socioeconomic position and the prevalence or incidence of atopic dermatitis were eligible for inclusion. Two independent reviewers screened all texts and extracted all data for qualitative synthesis. Eighty-eight studies met the inclusion criteria. Of the 88 studies, 42% (37) found a positive association between atopic dermatitis and socioeconomic position, 15% (13) found a negative association, and 43% (38) found a null or inconsistent association. Studies conducted in Europe, among children, and based on self-report of eczema were more likely to find a positive association with socioeconomic position. Studies varied both in terms of the measurement of socioeconomic position and the definition of atopic dermatitis, limiting quantitative synthesis. The evidence of a positive association between atopic dermatitis and socioeconomic position is not consistent.
Highlights
Atopic dermatitis is the most common chronic inflammatory skin condition, affecting up to 15-30% of children and 10-15% of adults worldwide, conferring a significant burden of disease (1)(2)(3)(4)
A 2015 systematic review examining the relationship between socioeconomic position (SEP) and allergic diseases concluded that there was a positive association between SEP and atopic dermatitis, with pooled estimates for the odds ratio of disease for the lowest compared with the highest
Full-text studies of individual-level epidemiologic design addressing the association between SEP and the prevalence or incidence of atopic dermatitis were eligible for inclusion, with no restrictions on participant age, sex, or race/ethnicity
Summary
Atopic dermatitis ( known as atopic eczema, or eczema) is the most common chronic inflammatory skin condition, affecting up to 15-30% of children and 10-15% of adults worldwide, conferring a significant burden of disease (1)(2)(3)(4). Lower socioeconomic position (SEP), based on estimates of income, educational attainment, occupational prestige, or subjective perceptions of social class and social status, is associated with poorer health outcomes for almost every disease studied (5). Numerous studies suggest that SEP may be positively associated with atopic dermatitis and other atopic diseases, possibly due to differences in the exposure to microorganisms important to immune system development and function (6)(7). The review had a broad focus on allergic disease and did not differentiate between participant characteristics or measures of SEP. These factors are important, because they could indicate different underlying mechanisms among different patient populations. Lower socioeconomic position usually portends worse health outcomes, but multiple studies have found that atopic dermatitis is associated with higher socioeconomic position, but the nature of this relationship remains unclear
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