Incidence Trends of Atopic Dermatitis in Infancy and Early Childhood in a Nationwide Prescription Registry Study in Norway

Abstract

Importance: With increasing prevalence of atopic dermatitis (AD) and its manifestation in most countries, together with the supporting evidence of the progression to other atopic phenotypes, AD has developed into a worldwide public health concern. The presence of the disease of has increased since the 1950s, but some recent studies suggest a stationary or decreasing trend.

Objective: To analyze a nationwide health register based on prescription data to determine the incidence rate (IR) of AD in an entire pediatric population.

Design, setting, and participants: All children resident in Norway younger than 6 years from January 1, 2009, through December 31, 2015, were included in this cohort study. Medical diagnoses and disease-specific medications were used as a proxy for identifying children with AD in this population-based prescription registry study. The prescription study was terminated in 2016. The total number of 295 286 disease-specific prescriptions was analyzed from August 2016 through December 2017. The hypothesis was formulated before, during, and after the data collection.

Main outcomes and measures: All children with a medical diagnosis of AD or eczema based on at least 2 prescriptions of topical corticosteroids or at least 1 prescription of topical calcineurin inhibitors. Incidence rates per person-year (PY) and IR ratios were calculated.

Results: A total of 295 286 disease-specific prescriptions were dispensed to 122 470 children, of whom 63 460 had AD and 56 009 (88.3%) had reimbursed prescriptions and associated AD diagnoses. The annual Norwegian study population (aged <6 years) increased from 357 451 children in 2009 to 373 954 in 2015. The overall IR increased from 0.028 per PY (95% CI, 0.028-0.029 per PY) in 2009 to 0.034 per PY (95% CI, 0.033-0.035 per PY) in 2014. For children younger than 1 year, the IR increased from 0.052 per PY (95% CI, 0.050-0.053 PY) in 2009 to 0.073 per PY (95% CI, 0.071-0.075 per PY) in 2014. In this age group, the IR was 53% higher in boys compared with girls (IR ratio, 1.53; 95% CI, 1.49-1.57; P < .001). The incidence proportion before the age of 6 years was 17.4% (95% CI, 17.2%-17.7%). The primary seasons for the onset of AD were winter and spring.

Conclusions and relevance: This nationwide study suggests an increase in the IR of pediatric AD, especially among children younger than 1 year. This study's findings suggest that increase occurred with a higher IR during winter and spring seasons. Atopic dermatitis had an earlier onset in boys than in girls. During the study period, more than 1 in 6 children younger than 6 years had, at some point, been affected by AD.

Figure 1.. Incidence Rate (IR) per Person-Year (PY) of Atopic Dermatitis During the First 6 Years of Life

Data are from the Norwegian Prescription Database from January 1, 2009, through December 31, 2015. Error bars indicate 95% CI. The upper curve displays the IR per PY determined by reimbursed (criterion 1) and nonreimbursed (criterion 2) medications as proxies for atopic dermatitis; the lower curve (year 2009-2015) displays the IR for reimbursed medication only (criterion 1).

Figure 2.. The Incidence Rate (IR) per Person-Year (PY) in Children With Atopic Dermatitis According to the Indicated Age Group

Data are from the Norwegian Prescription Database from January 1, 2009, through December 31, 2015. Error bars indicate 95% CI.

Figure 3.. The Interaction of the Incidence Rate (IR) per Person-Year (PY) of Atopic Dermatitis Between Age and Sex

Includes boys and girls younger than 6 years. Data are from the Norwegian Prescription Database from January 1, 2009, through December 31, 2014. Error bars indicate 95% CI.

Figure 4.. The Annual Incidence Rate (IR) per Person-Year (PY) of Atopic Dermatitis for Boys and Girls

Includes children younger than 6 years. Data are from the Norwegian Prescription Database from January 1, 2009, through December 31, 2014. Error bars indicate 95% CI.