The epidemiology of eczema in children and adults in England: A population‐based study using primary care data

Abstract

Background Whilst eczema is a common inflammatory skin condition, we lack contemporary estimates of disease incidence and prevalence across the lifespan. Objective To estimate the incidence and prevalence of eczema in children and adults in England and variation by sociodemographic factors (sex, socio‐economic status, ethnicity, and geography). Methods We used the Royal College of General Practitioners Research and Surveillance Centre primary care research database of 3.85 million children and adults registered with participating general practitioner practices between 2009 and 2018 inclusive. Eczema incidence was defined as the first‐ever diagnosis of eczema recorded in the primary care record, and eczema prevalence was defined as fulfilment of criteria for active eczema (two eczema records appearing in the primary care record within any one‐year period). Results Eczema incidence was highest in infants younger than 1 year (15.0 per 100 person‐years), lowest in adults aged 40–49 (0.35 p/100 person‐years), and increased from middle age to a second smaller peak in people 80 years or older (0.79 p/100 person‐years). Eczema prevalence was highest in children aged 2 (16.5%) and lowest in adults aged 30–39 (2.8%). Eczema incidence was higher in male infants (<2) and male adults older than 70; for all other ages, incidence was higher in females. Eczema was more common in Asian and black ethnic groups than in people of white ethnicity. Higher socio‐economic status was associated with a greater incidence of eczema in infants younger than 2, but the reverse was seen for all other age groups. Both incidence and prevalence of eczema were greater in urban settings and in North‐West England. Conclusions and Clinical Relevance Eczema has a bimodal distribution across the lifespan. We observed differences in incidence and prevalence of eczema by ethnicity, geography, sex, and socio‐economic status, which varied in magnitude throughout life.

The epidemiology of atopic dermatitis in older adults: A population-based study in the United Kingdom

“…Although there are a few other studies that focus specifically on the epidemiology of atopic dermatitis among older adults, review of additional population-based cohorts, including the US NHANES validation cohort presented herein, the 2010 US National Health Interview Survey (NHIS) data [ 23 ], and two additional UK-based sources [ 24 , 25 ] support our findings. The period prevalence of self-reported atopic dermatitis in the 2010 NHIS was similar to our findings: 9.0% among younger adults ages 18–32 and 11.4% among older adults ages 62–85.…”

“…A systematic review and meta-analysis found that atopic dermatitis is more common among groups with higher SES, though these were primarily studies of children [ 33 ]. More recent studies have found that this association was strongest early in life, but that atopic dermatitis was more common among lower socioeconomic groups in adulthood or did not vary by SES [ 5 , 25 , 34 ]. Additional study is warranted to explore possible mechanisms for these findings.…”

Dietary management of breastfed children with food allergy

“…Anecdotal evidence suggests benefit of maternal dietary restriction for some children with chronic symptoms associated with food allergy, such as eczema 4 . Eczema is the most burdensome skin condition worldwide, with a high prevalence during the first 2 years of life 8 and limited non‐pharmacological options for management. Some families may feel that maternal dietary restriction is safer than using medical products such as skin creams, wash products and topical anti‐inflammatories.…”

The power and potential of BIOMAP to elucidate host‐microbiome interplay in skin inflammatory diseases

“…The healthy skin microbiota changes considerably throughout life, with Staphylococcus and Streptococcus dominating in infancy, while Cutibacterium and Corynebacterium are more abundant in adulthood (Figure 2A). 67,70,124,125 Interestingly, the prevalence of AD is highest in the first years of life, with a considerable decline around school age 126,127 (Figure 2B), and while AD can resolve in some cases, for others it becomes a lifelong condition. 86 Interestingly, the skin microbiota in young children is also quite different from that of older children and adults.…”