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

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 t...

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Autores principales: Mohn, Cathrine H., Blix, Hege Salvesen, Halvorsen, Jon Anders, Nafstad, Per, Valberg, Morten, Lagerløv, Per
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6324394/
https://www.ncbi.nlm.nih.gov/pubmed/30646341
http://dx.doi.org/10.1001/jamanetworkopen.2018.4145
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author Mohn, Cathrine H.
Blix, Hege Salvesen
Halvorsen, Jon Anders
Nafstad, Per
Valberg, Morten
Lagerløv, Per
author_facet Mohn, Cathrine H.
Blix, Hege Salvesen
Halvorsen, Jon Anders
Nafstad, Per
Valberg, Morten
Lagerløv, Per
author_sort Mohn, Cathrine H.
collection PubMed
description 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.
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spelling pubmed-63243942019-01-22 Incidence Trends of Atopic Dermatitis in Infancy and Early Childhood in a Nationwide Prescription Registry Study in Norway Mohn, Cathrine H. Blix, Hege Salvesen Halvorsen, Jon Anders Nafstad, Per Valberg, Morten Lagerløv, Per JAMA Netw Open Original Investigation 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. American Medical Association 2018-11-02 /pmc/articles/PMC6324394/ /pubmed/30646341 http://dx.doi.org/10.1001/jamanetworkopen.2018.4145 Text en Copyright 2018 Mohn CH et al. JAMA Network Open. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Mohn, Cathrine H.
Blix, Hege Salvesen
Halvorsen, Jon Anders
Nafstad, Per
Valberg, Morten
Lagerløv, Per
Incidence Trends of Atopic Dermatitis in Infancy and Early Childhood in a Nationwide Prescription Registry Study in Norway
title Incidence Trends of Atopic Dermatitis in Infancy and Early Childhood in a Nationwide Prescription Registry Study in Norway
title_full Incidence Trends of Atopic Dermatitis in Infancy and Early Childhood in a Nationwide Prescription Registry Study in Norway
title_fullStr Incidence Trends of Atopic Dermatitis in Infancy and Early Childhood in a Nationwide Prescription Registry Study in Norway
title_full_unstemmed Incidence Trends of Atopic Dermatitis in Infancy and Early Childhood in a Nationwide Prescription Registry Study in Norway
title_short Incidence Trends of Atopic Dermatitis in Infancy and Early Childhood in a Nationwide Prescription Registry Study in Norway
title_sort incidence trends of atopic dermatitis in infancy and early childhood in a nationwide prescription registry study in norway
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6324394/
https://www.ncbi.nlm.nih.gov/pubmed/30646341
http://dx.doi.org/10.1001/jamanetworkopen.2018.4145
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