Abstract
Atopic dermatitis is known to be common among children, but there are few studies examining the epidemiology across the life course. In particular, there is a paucity of data on atopic dermatitis among older adults. To evaluate participant characteristics, patterns of disease activity and severity, and calendar trends in older adult atopic dermatitis in comparison to other age groups in a large population-based cohort. This was a cohort study of 9,154,936 individuals aged 0-99 years registered in The Health Improvement Network, a database comprised of electronic health records from general practices in the United Kingdom between 1994 and 2013. Atopic dermatitis was defined by a previously validated algorithm using a combination of at least one recorded atopic dermatitis diagnostic code in primary care and two atopic dermatitis therapies recorded on separate days. Cross-sectional analyses of disease prevalence were conducted at each age. Logistic mixed effect regression models were used to identify predictors of prevalent disease over time among children (0-17 years), adults (18-74 years), and older adults (75-99 years). Physician-diagnosed atopic dermatitis was identified in 894,454 individuals with the following proportions in each age group: 18.3% of children, 7.7% of adults, and 11.6% of older adults. Additionally, atopic dermatitis prevalence increased across the 2-decade period (beta from linear regression test for trend in the change in proportion per year = 0.005, p = 0.044). In older adults, atopic dermatitis was 27% less common among females (adjusted OR 0.73, 95% CI 0.70-0.76) and was more likely to be active (59.7%, 95% CI 59.5-59.9%) and of higher severity (mean annual percentage with moderate and severe disease: 31.8% and 3.0%, respectively) than in other age groups. In a large population-based cohort, the prevalence of physician-diagnosed atopic dermatitis has increased throughout adulthood and was most common among males age 75 years and above. Compared to children ages 0-17 and adults ages 18-74, older adult atopic dermatitis was more active and severe. Because the prevalence of atopic dermatitis among older adults has increased over time, additional characterization of disease triggers and mechanisms and targeted treatment recommendations are needed for this population.
Highlights
IntroductionAtopic dermatitis ( known as atopic eczema, or eczema) is a common inflammatory condition that manifests as dry, severely itchy skin [1]
Atopic dermatitis is a common inflammatory condition that manifests as dry, severely itchy skin [1]
In a large population-based cohort, the prevalence of physician-diagnosed atopic dermatitis has increased throughout adulthood and was most common among males age 75 years and above
Summary
Atopic dermatitis ( known as atopic eczema, or eczema) is a common inflammatory condition that manifests as dry, severely itchy skin [1]. In particular, have not been well-represented in epidemiologic studies of atopic dermatitis nor in clinical trials for novel treatments [4]. Differences in both demographic characteristics and clinical manifestations of atopic dermatitis have been identified between children and adults, demonstrating the importance of studying atopic dermatitis past childhood [2, 5, 6]. Older adults are often affected by other health conditions that may influence atopic dermatitis treatment choice These unique considerations underscore the importance of studying the epidemiology and disease characteristics of atopic dermatitis in the older adult population. There is a paucity of data on atopic dermatitis among older adults
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