Reliably estimating prevalences of atopic children: an epidemiological study in an extensive and representative primary care database

Abstract

Electronic health records stored in primary care databases might be a valuable source to study the epidemiology of atopic disorders and their impact on health-care systems and costs. However, the prevalence of atopic disorders in such databases varies considerably and needs to be addressed. For this study, all children aged 0–18 years listed in a representative primary care database in the period 2002–2014, with sufficient data quality, were selected. The effects of four different strategies on the prevalences of atopic disorders were examined: (1) the first strategy examined the diagnosis as recorded in the electronic health records, whereas the (2) second used additional requirements (i.e., the patient had at least two relevant consultations and at least two relevant prescriptions). Strategies (3) and (4) assumed the atopic disorders to be chronic based on strategy 1 and 2, respectively. When interested in cases with a higher probability of a clinically relevant disorder, strategy 2 yields a realistic estimation of the prevalence of atopic disorders derived from primary care data. Using this strategy, of the 478,076 included children, 28,946 (6.1%) had eczema, 29,182 (6.1%) had asthma, and 28,064 (5.9%) had allergic rhinitis; only 1251 (0.3%) children had all three atopic disorders. Prevalence rates are highly dependent on the clinical atopic definitions used. The strategy using cases with a higher probability of clinically relevant cases, yields realistic prevalences to establish the impact of atopic disorders on health-care systems. However, studies are needed to solve the problem of identifying atopic disorders that are missed or misclassified.

Childhood asthma prevalence: cross-sectional record linkage study comparing parent-reported wheeze with general practitioner-recorded asthma diagnoses from primary care electronic health records in Wales

“…Punekar and Sheikh 5 estimated an 18-year period prevalence of clinician-diagnosed asthma in children and adolescents across the UK to be 22.9% (95% CI 22.3% to 23.4%) from practices contributing to the General Practice Research Database. In one study from the Netherlands, Pols et al 18 estimated the prevalence of childhood asthma to be 6.1%, based on the requirement of at least two relevant consultations and at least two relevant prescriptions in the primary care record. This is closer to our estimate, which also included use of primary care-coded prescription as well as diagnosis.…”

Risks for comorbidity in children with atopic disorders: an observational study in Dutch general practices

“…In practice, an atopic episode of care was maintained if (between 2002 and 2014) the parent of the child had at least contacted the GP twice in that episode of care and had received at least two relevant prescriptions. If the child did not meet these criteria, the child was considered not to have that atopic disorder 29 and was excluded from the study (this child could not be used as a control patient, to make sure that controls did not have any atopic disorder). If a child was diagnosed with an atopic disorder for the first time during 2014, the child was considered to have the atopic disorder that whole year.…”

Different potencies of topical corticosteroids for a better treatment strategy in children with atopic dermatitis (the Rotterdam Eczema study): protocol for an observational cohort study with an embedded randomised open-label controlled trial

“…It is estimated that 10%–20% of children and 1%–3% of adults in developed countries are affected by the disorder 4. In the Netherlands, cumulative incidence of AD at age 18 years is at least 24% 5. AD often starts in early infancy; about 45% of all cases begin within the first 6 months of life, 60% during the first year and 85% before 5 years of age 6.…”