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JAMA Netw Open. 2018 Nov 2;1(7):e184145. doi: 10.1001/jamanetworkopen.2018.4145.

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

Author information

1
Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.
2
Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Oslo, Norway.
3
Department of Dermatology, Institute of Clinical Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway.
4
Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.
5
Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway.
6
Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital and University of Oslo, Oslo, 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.

PMID:
30646341
PMCID:
PMC6324394
DOI:
10.1001/jamanetworkopen.2018.4145
[Indexed for MEDLINE]
Free PMC Article

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