Original article
Assessment of major comorbidities in adults with atopic dermatitis using the Charlson comorbidity index

https://doi.org/10.1016/j.jaad.2017.01.030Get rights and content

Background

There is a growing interest in comorbidities of adults with atopic dermatitis (AD).

Objectives

To examine the burden of comorbidities in adult patients with AD using the Charlson comorbidity index (CCI) in nationwide registries.

Methods

All Danish patients ≥18 years on January 1, 2012 with AD diagnosed by a hospital dermatologist were included. Patients were age-and sex-matched in a 1:4 ratio with general population controls. Severity was determined by systemic AD treatment and analyzed by conditional logistic regression.

Results

In total, 10,738 adult patients with AD and 42,952 controls were analyzed. CCI score was significantly increased in smokers with AD compared with controls (0.41 vs 0.13, P < .001). Nonsmokers with AD had a similar CCI score as controls (0.09 vs 0.08, P = .12). In analyses restricted to patients with severe AD, a stronger difference in CCI score was observed for smokers (0.48 vs 0.14, P < .001) than for nonsmokers (0.10 vs 0.08, P = .01).

Limitations

Observational studies do not establish cause and effect.

Conclusion

On the basis of nationwide data, the risk for major comorbidities was significantly increased in adult patients with AD compared with controls. The risk difference was predominantly found in patients with severe disease and among smokers.

Section snippets

Data sources and study population

Danish nationwide registries can be linked at the individual level.17 The Danish National Patient Register18 contains information on in- and outpatient (ambulatory) hospital consultations according to the ICD classification. The Danish Registry of Medicinal Products Statistics19 records information on all pharmacy-dispensed medications according to the international Anatomical Therapeutic Chemical classification.

Medication dispensed during hospitalization or given directly from ambulatory

Results

A total of 10,738 adult patients with AD and 42,952 age- and sex-matched controls were analyzed (Table I). Higher proportions of patients with AD belonged to the highest socioeconomic class. About half of patients with AD had severe disease. The proportion of smokers was significantly higher among AD patients than among controls (11.2% vs 7.6%, P < .001). Tables II and III show the CCI scores for patients with AD and controls. Overall, AD patients had a significantly higher CCI score than

Discussion

We found significantly higher concurrences of major comorbidities in AD patients, and in particular among those with severe AD (possibly owing to systemic anti-AD treatment) and a history of smoking tobacco. AD is associated with impaired quality of life and psychiatric comorbidity.3, 4, 25, 26, 27 The link with autoimmune disease might partly be explained by overlapping genetic predispositions,5 but the AD-associated risk for rheumatoid arthritis and inflammatory bowel disease also might owe

References (31)

  • R. Kantor et al.

    Association of atopic dermatitis with smoking: a systematic review and meta-analysis

    J Am Acad Dermatol

    (2016)
  • G.R. Vinding et al.

    Is adult atopic eczema more common than we think? A population-based study in Danish adults

    Acta dermato-venereologica

    (2014)
  • G.C. Mohan et al.

    Association of vitiligo and alopecia areata with atopic dermatitis: a systematic review and meta-analysis

    JAMA dermatology

    (2015)
  • S. Deckert et al.

    Nonallergic comorbidities of atopic eczema: an overview of systematic reviews

    Allergy

    (2014)
  • J.I. Silverberg

    Association between adult atopic dermatitis, cardiovascular disease, and increased heart attacks in three population-based studies

    Allergy

    (2015)
  • Cited by (0)

    Funding sources: None.

    Conflicts of interest: Dr Thyssen is supported by an unrestricted grant from the Lundbeck Foundation and has attended advisory board meetings for Roche and Sanofi-Genzyme. Dr Skov has received consultancy and speaker honoraria from Abbvie, Pfizer, Janssen-Cilag, Merck Sharp & Dohme, and Leo Pharma and is a member of the advisory boards of Abbvie, Pfizer, Janssen-Cilag, Merck Sharp & Dohme, Eli Lilly, Celgene, and Novartis. Dr Hamann has no relevant conflicts of interest to declare. Dr Gislason is supported by an unrestricted research scholarship from the Novo Nordisk Foundation. Dr Egeberg has received research funding from Pfizer and Eli Lilly, and honoraria for consulting and speaking for Pfizer, Eli Lilly, Novartis, Galderma, and Janssen Pharmaceuticals.

    Reprints not available from the authors.

    View full text