The impact of childhood atopic dermatitis (AD) on social and behavioral issues is not well understood.
Objective
This study sought to determine the prevalence and predictors of social and behavioral symptoms and functional impairment among US children with AD.
Methods
The 1996 to 2015 Medical Expenditure Panel Surveys were analyzed, including a representative, cross-sectional study of 2553 US children with AD. Behavioral and functional issues were examined using Columbia Impairment Scale (CIS) scores.
Results
Childhood AD was associated with behavioral and functional problems, particularly nervousness (odds ratio [OR], 1.18; 95% confidence interval [95% CI], 1.06–1.31), home behavior (OR, 1.18; 95% CI, 1.06–1.32), staying out of trouble (OR, 1.18; 95% confidence interval, 1.06–1.31), and relationships with other kids (OR, 1.17; 95% CI, 1.05–1.31) and with siblings (OR, 1.14; 95% CI, 1.02–1.28). Higher CIS scores were present in children with AD versus without AD (adjusted β, 0.62; 95% CI, 0.22–1.02) and with psoriasis (adjusted β, 0.86; 95% CI, 0.22–1.49). Among children with AD, higher CIS scores were notably associated with male sex, older age, lower household income, public insurance, and comorbid depression and anxiety.
Conclusions
AD was associated with behavioral and functional impairment, similar to psoriasis and other common chronic conditions. There are significant sociodemographic differences in CIS scores.
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References
1.
SilverbergJI, GelfandJM, MargolisDJ, et al.Patient burden and quality of life in atopic dermatitis in US adults: a population-based cross-sectional study. Ann Allergy Asthma Immunol, 2018; 121(3):340–347.
2.
YaghmaieP, KoudelkaCW, SimpsonEL. Mental health comorbidity in patients with atopic dermatitis. J Allergy Clin Immunol, 2013; 131(2):428–433.
3.
StromMA, FishbeinAB, PallerAS, et al. Association between atopic dermatitis and attention deficit hyperactivity disorder in U.S. children and adults. Br J Dermatol, 2016; 175(5):920–929.
4.
PatelKR, ImmaneniS, SingamV, et al.Association between atopic dermatitis, depression, and suicidal ideation: a systematic review and meta-analysis. J Am Acad Dermatol, 2019; 80(2):402–410.
5.
HonKL, LeungTF, WongKY, et al.Does age or gender influence quality of life in children with atopic dermatitis?. Clin Exp Dermatol, 2008; 33(6):705–709.
6.
WanJ, TakeshitaJ, ShinDB, et al.Mental health impairment among children with atopic dermatitis: a United States population-based cross-sectional study of the 2013–2017 National Health Interview Survey. J Am Acad Dermatol, 2020; 82(6):1368–1375.
7.
SilverbergJI, SimpsonEL. Associations of childhood eczema severity: a US population-based study. Dermatitis, 2014; 25(3):107–114.
8.
McKenzieC, SilverbergJI. The prevalence and persistence of atopic dermatitis in urban United States children. Ann Allergy Asthma Immunol, 2019; 123(2):173–8.e1.
9.
Medical Expenditure Panel Survey, MEPS survey questionnaires, household questionnaire sections [Internet]. Agency for Healthcare Research and Quality. Available at: http://meps.ahrq.gov/mepsweb/survey_comp/survey.jsp. Accessed July7, 2020.
10.
von ElmE, AltmanDG, EggerM, et alSTROBEInitiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet, 2007; 370(9596):1453–1457.
11.
FischerAH, ShinDB, MargolisDJ, et al.Racial and ethnic differences in health care utilization for childhood eczema: an analysis of the 2001–2013 Medical Expenditure Panel Surveys. J Am Acad Dermatol, 2017; 77(6):1060–1067.
12.
HurwitzS.Hurwitz's Clinical Pediatric Dermatology: A Textbook of Skin Disorders of Childhood and Adolescence. 5th ed. Paller A, Mancini AJ, eds. Edinburgh: Elsevier;. 2016.
13.
BirdHR, AndrewsH, Schwab-StoneM, et al.Global measures of impairment for epidemiologic and clinical use with children and adolescents. Int J Methods Psychiatr Res, 1996; 6(4):295–307.
14.
HarrisES, CanningRD, KelleherKJ. A comparison of measures of adjustment, symptoms, and impairment among children with chronic medical conditions. J Am Acad Child Adolesc Psychiatry, 1996; 35(8):1025–1032.
15.
SullivanPW, GhushchyanV, NavaratnamP, et al.Indicators of poorly controlled asthma and health-related quality of life among school-age children in the United States. Allergy Asthma Proc, 2017; 38(6):431–439.
16.
SilverbergJI, SimpsonEL. Association between severe eczema in children and multiple comorbid conditions and increased healthcare utilization. Pediatr Allergy Immunol, 2013; 24(5):476–486.
17.
SilverbergJI, GelfandJM, MargolisDJ, et al.Measurement properties of the Hospital Anxiety and Depression Scale used in atopic dermatitis in adults. J Invest Dermatol, 2019; 139(6):1388–1391.
18.
ThyssenJP, SkovL, HamannCR, et al.Assessment of major comorbidities in adults with atopic dermatitis using the Charlson Comorbidity Index. J Am Acad Dermatol, 2017; 76(6):1088–92.e1.
19.
ChengBT, SilverbergNB, SilverbergJI. Association of childhood atopic dermatitis with atopic and nonatopic multimorbidity. Dermatitis, 2020; doi: 10.1097/DER.0000000000000644.
20.
Lewis-JonesS.Quality of life and childhood atopic dermatitis: the misery of living with childhood eczema. Int J Clin Pract, 2006; 60(8):984–992.
21.
JangHJ, HwangS, AhnY, et al.Family quality of life among families of children with atopic dermatitis. Asia Pac Allergy, 2016; 6(4):213–219.
22.
MarciniakJ, ReichA, SzepietowskiJC. Quality of life of parents of children with atopic dermatitis. Acta Derm Venereol, 2017; 97(6):711–714.
23.
ChamlinSL, MattsonCL, FriedenIJ, et al.The price of pruritus: sleep disturbance and cosleeping in atopic dermatitis. Arch Pediatr Adolesc Med, 2005; 159(8):745–750.
24.
KruseLL, CicesA, FishbeinAB, et al.Neurocognitive function in moderate-severe pediatric atopic dermatitis: a case-control study. Pediatr Dermatol, 2019; 36(1):110–114.
25.
GoudieA, HavercampS, JamiesonB, et al.Assessing functional impairment in siblings living with children with disability. Pediatrics, 2013; 132(2):e476–e483.
26.
WanJ, MargolisDJ, MitraN, et al.Racial and ethnic differences in atopic dermatitis–related school absences among US children. JAMA Dermatol, 2019; e190597.
27.
Chiesa FuxenchZC, BlockJK, BoguniewiczM, et al.Atopic dermatitis in america study: a cross-sectional study examining the prevalence and disease burden of atopic dermatitis in the US adult population. J Invest Dermatol, 2019; 139(3):583–590.
28.
KantorR, DalalP, CellaD, et al.Research letter: impact of pruritus on quality of life—a systematic review. J Am Acad Dermatol, 2016; 75(5):885–6.e4.
29.
SilverbergJI, KantorRW, DalalP, et al.A comprehensive conceptual model of the experience of chronic itch in adults. Am J Clin Dermatol, 2018; 19(5):759–769.
30.
VakhariaPP, ChopraR, SacotteR, et al.Burden of skin pain in atopic dermatitis. Ann Allergy Asthma Immunol, 2017; 119(6):548–52.e3.
31.
SuárezAL, FeramiscoJD, KooJ, et al.Psychoneuroimmunology of psychological stress and atopic dermatitis: pathophysiologic and therapeutic updates. Acta Derm Venereol, 2012; 92(1):7–15.
32.
BridgmanAC, EshtiaghiP, Cresswell-MelvilleA, et al.The burden of moderate to severe atopic dermatitis in Canadian children: a cross-sectional survey. J Cutan Med Surg, 2018; 22(4):443–444.
33.
NaCH, ChungJ, SimpsonEL. Quality of life and disease impact of atopic dermatitis and psoriasis on children and their families. Children (Basel), 2019; 6(12):133.
34.
KwaL, SilverbergJI. Financial burden of emergency department visits for atopic dermatitis in the United States. J Am Acad Dermatol, 2018; 79(3):443–447.
35.
NarlaS, HsuDY, ThyssenJP, et al.Predictors of hospitalization, length of stay, and costs of care among adult and pediatric inpatients with atopic dermatitis in the United States. Dermatitis, 2018; 29(1):22–31.
36.
ChengBT, SilverbergJI. Predictors of hospital readmission in US children and adults with atopic dermatitis. Ann Allergy Asthma Immunol, 2019; 123(1):64–69.e2.
37.
SilverbergJI, GelfandJM, MargolisDJ, et al.Atopic dermatitis in US adults: from population to health care utilization. J Allergy Clin Immunol Pract, 2019; 7(5):1524–32.e2.
38.
BoguniewiczM, FonacierL, Guttman-YasskyE, et al.Atopic dermatitis yardstick: practical recommendations for an evolving therapeutic landscape. Ann Allergy Asthma Immunol, 2018; 120(1):10–22.e2.
