Effect of Disease Severity on Comorbid Conditions in Atopic Dermatitis: Nationwide Registry-Based Investigation in Finnish Adults

Abstract

The majority of registry studies on atopic dermatitis include only patients and diagnoses from specialized healthcare. The aim of this retrospective, real-world cohort study was to evaluate the effect of atopic dermatitis severity on comorbidities and total morbidity, with comprehensive data from both primary and specialty healthcare registries covering the entire Finnish adult population. In total, 124,038 patients were identified (median age 46 years; 68% female) and stratified by disease severity. All regression analyses (median follow-up 7.0 years) were adjusted at a minimum for age, sex, obesity, and educational level. Compared with mild atopic dermatitis, severe atopic dermatitis was significantly associated with multiple morbidities, including neurotic, stress-related and somatoform disorders, abscesses, erysipelas/cellulitis, impetigo, herpes zoster, extragenital herpes, bacterial conjunctivitis, septicaemia, lymphomas, alopecia areata, urticaria, other dermatitis, contact allergy, osteoporosis, and intervertebral disc disorders (p < 0.001). In addition, there were significant associations with alcohol dependence, depression, condylomas, rosacea, migraine, sleep apnoea, hypertension, enthesopathies, atherosclerosis, and drug-induced cataract (p < 0.05). Odds ratios were modest and mostly were between 1.10 and 2.75. Furthermore, patients with severe atopic dermatitis had lower incidences of prostate cancer, cystitis, and anogenital herpes than patients with mild atopic dermatitis (p < 0.05). These results suggest that severe atopic dermatitis results in significant overall morbidity.

Real‐world treatment patterns of Finnish adult patients with atopic dermatitis: From topicals to systemic therapy

“…Hence, the cohort is clearly skewed towards moderate to severe AD. Further limitations concerning the cohort formation and severity class stratification are described in our previous publication 13 . Notably, the collected patient data does not include descriptions of the affected body surface area, which may affect the outcome of the use of topical therapies (PPY).…”

“…This was a retrospective registry study utilizing electronic medical records gathered from social‐ and healthcare registers from both primary and secondary healthcare providers in Finland between 1 January 2005 and 31 December 2019. Detailed description of the cohort formation is presented in our previous publication 13 . Briefly, the data was gathered from six nationwide registers, the National Institute of Health and Welfare, the Social Insurance Institution of Finland, the Finnish Centre for Pensions, Statistics Finland, and the largest two nationwide private healthcare providers (Terveystalo and Mehiläinen).…”

“…For newly diagnosed AD patients, these treatments were considered from the year before index (diagnosis or reimbursement number for AD) until the end of follow‐up (death or 31 December 2019). A detailed description of all the used index‐timepoints is presented in our previous publication 13 . For prevalent patients, treatments were considered from 2005 until the end of follow‐up.…”

“…In our previous work, we studied the association of AD severity with comorbidities in a Finnish nationwide analysis. 13 The aim of the current study was to supplement the previous description by characterising the treatment pathways of the overall AD patient population, from topical treatment options to systemic therapy, forming the first comprehensive realworld cohort study in Finland. Further, the study aimed to provide an in-depth description of the recent treatment practices for severe AD in secondary healthcare.…”

Anxiety and depression in patients with hand eczema: A population‐based study among 853 middle‐aged subjects

“…Those with more severe AD are commonly sent for hospital consultation. Since AD is known to be associated with depression and anxiety and the risk increases according to the severity of the disease, [20][21][22] we excluded from the analysis those (n = 51) with at least one note of diagnosis of AD in CRHC (indirectly defined as 'severe AD').…”