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. 2021 Oct 6;16(10):e0258219.
doi: 10.1371/journal.pone.0258219. eCollection 2021.

The epidemiology of atopic dermatitis in older adults: A population-based study in the United Kingdom

Leslie N Chan  1 , Alexa Magyari  2 , Morgan Ye  3 , Noor A Al-Alusi  1 , Sinead M Langan  4 , David Margolis  5 , Charles E McCulloch  6 , Katrina Abuabara  3
Affiliations

The epidemiology of atopic dermatitis in older adults: A population-based study in the United Kingdom

Leslie N Chan et al. PLoS One. .

Abstract

Background: 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.

Objective: 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.

Methods: 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).

Results: 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.

Conclusion: 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.

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Conflict of interest statement

I have read the journal’s policy and the authors of this manuscript have the following competing interests: KA is a consultant for TARGET RWE, a company developing an atopic disease research registry, and her institution receives investigator-initiated grants from Pfizer and Cosmetique Active Internacional SNC. DJM receives funding to the University of Pennsylvania from Valeant for studies not directly related to this manuscript. He receives consulting funds from Leo, Sanofi, and Pfizer for topics related to atopic eczema but not this manuscript. No other disclosures were reported. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Graphical depiction of study design.
Participants were followed for up to 20 years at differing ages; if individuals met atopic dermatitis diagnosis criteria, they were assessed for active disease during each subsequent year of follow-up.
Fig 2
Fig 2. Annual period prevalence of atopic dermatitis by participant characteristic and calendar period.
Local polynomial smoothed plots with shading indicating the 95% CIs generated from yearly cross-sectional calculations of the proportion of participants with prevalent atopic dermatitis from ages 0 to 99.
Fig 3
Fig 3. Atopic dermatitis severity, by age group.
Mean percentage of patients in each age group (children, adults, and older adults) that meet the definition for mild, moderate, and severe atopic dermatitis. Bars indicate 95% confidence intervals.
See this image and copyright information in PMC

References

    1. Langan SM, Irvine AD, Weidinger S. Atopic dermatitis. Lancet. 2020. Aug 1;396(10247):345–60. doi: 10.1016/S0140-6736(20)31286-1 - DOI - PubMed
    1. Silverberg JI. Atopic Dermatitis in Adults. Med Clin NA. 2020;104(1):157–76. - PubMed
    1. Abuabara K, Magyari A, McCulloch CE, Linos E, Margolis DJ, Langan SM. Prevalence of atopic eczema among patients seen in primary care: Data from the health improvement network. Ann Intern Med. 2019;170(5):354–6. doi: 10.7326/M18-2246 - DOI - PMC - PubMed
    1. Lam M, Zhu JW, Maqbool T, Adam G, Tadrous M, Rochon P, et al.. Inclusion of Older Adults in Randomized Clinical Trials for Systemic Medications for Atopic Dermatitis: A Systematic Review. JAMA Dermatology. 2020. Nov 1;156(11):1240–5. doi: 10.1001/jamadermatol.2020.2940 - DOI - PubMed
    1. Abuabara K, Ye M, McCulloch CE, Sullivan A, Margolis DJ, Strachan DP, et al.. Clinical onset of atopic eczema: Results from 2 nationally representative British birth cohorts followed through midlife. J Allergy Clin Immunol. 2019. Jun 28;144(3):710–9. doi: 10.1016/j.jaci.2019.05.040 - DOI - PMC - PubMed

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