Diagnosis validation and clinical characterization of atopic dermatitis in Nurses’ Health Study 2

Abstract

Background Epidemiologic studies of atopic dermatitis (AD) are often limited by case definitions that have not been validated. Objective In this study, we assessed the accuracy of self‐report of AD in a large cohort of US female nurses, the Nurses’ Health Study 2 (NHS2). We also provide clinical characteristics of AD in the cohort. Methods We sent an electronic questionnaire to NHS2 participants who previously reported ever having a diagnosis of AD. This questionnaire was designed to confirm cases of AD using previously validated algorithms with >85% specificity. We assessed the association of AD with asthma, comparing the results when different definitions of AD were applied. We also inquired about various aspects of participants’ AD. Results Responses were received from 2509 of 5126 (49%) nurses who were sent the questionnaire, with an average age of 62. Most participants (1996/2509, 80%) reiterated their previously reported clinician diagnosis of AD. Application of the two diagnostic algorithms yielded confirmation of 1538 and 1293 prevalent cases, respectively. The association of AD with asthma was stronger when more stringent AD case definitions were applied. Participants generally reported mild disease (92% with ≤10% maximal body surface area involved) and a high proportion (57%) reported adult‐onset disease. Conclusions Self‐report of AD diagnosis has good reliability, and future analyses will be strengthened by our ability to conduct sensitivity analyses with refined confirmed AD subgroups.

Depressive Symptoms and Sleep Disturbance in Female Nurses with Atopic Dermatitis: The Korea Nurses’ Health Study

“…In this study, the rate of AD patients who also had sleep disturbance was 49.2%, which was significantly higher than that of the no AD group (37.7%). The study that analyzed AD cases from the NHS2 in the United States reported that the proportion of nurses who experienced sleep disturbance when AD symptoms were the worst was 40% [23]. Although a direct comparison is difficult, since this study did not investigate the degree of AD symptoms, the fact that about half of nurses in Korea and the United States experience sleep disturbance implies that the healthcare of nurses with AD should address sleep problems.…”

“…It is meaningful to examine the prevalence of AD among nurses, since the prevalence of AD differs according to occupation [30] and having AD is known to affect presenteeism, overall work impairment, and activity impairment [31]. A previous study that analyzed NHS2 data reported that 57% of nurses with AD were diagnosed with it as an adult [23], suggesting that the cause of such a high prevalence of AD among nurses is the nursing job. However, this study did not include the exact time of diagnosis of AD, making it difficult to identify whether the high prevalence of AD among nurses was related to the work shift of the nurse.…”

“…A higher score indicates a more depressed condition. The depressive symptoms were classified into five levels: minimal (0-4), mild (5-9), moderate (10)(11)(12)(13)(14), moderately severe (15)(16)(17)(18)(19), and severe (20)(21)(22)(23)(24)(25)(26)(27). The cutoff point for depressive symptoms was defined as PHQ-9 ≥ 10 [25].…”

“…Most studies of depression or sleep problems among AD patients have focused on adult patients [17,22]. The AD epidemiologic studies of female nurses conducted by the US NHS did not include depressive symptoms and investigated only cases of severe AD symptoms related to sleep disturbance [7,23].…”

Prevalence and Risk Factors of COVID-19 Symptoms among U.S. Adults with Allergies

“…Additionally, patients with allergies have impaired secretion of innate interferons which can increase their risk of developing respiratory viral infections [ 18 ]. Our data are limited as details regarding type of allergy or allergic condition are not available, although reliability of self-reported allergic conditions has been previously established in other cohorts [ 20 ]. We were able to adjust for self-reported asthma in our models, evaluating physical and mental health symptoms to adjust for the potential confounding effects of a comorbid asthmatic condition.…”