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Poor agreement in questionnaire-based diagnostic criteria for adult atopic dermatitis is a challenge when examining
Y M F Andersen1,2,3, A Egeberg1,2, C R Hamann1,2,3
1Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
Insights
This study explored the link between atopic dermatitis (AD) and cardio-metabolic risks in adults. Different diagnostic criteria yielded varied results, highlighting the need for better definitions in epidemiological studies.
Area of Science:
- Epidemiology
- Dermatology
- Cardiology
Background:
- The association between atopic dermatitis (AD) and cardio-metabolic risk factors remains unclear.
- Currently, no validated questionnaire-based method exists to identify adults with AD.
Purpose of the Study:
- To evaluate cardio-metabolic risk in adults with a history of AD.
- To compare three distinct questionnaire-based diagnostic criteria for identifying AD in adults.
Main Methods:
- Utilized data from a general population study of 9656 Danish adults.
- Employed self-reported physician-diagnosed AD and two versions of the UK Working Party Diagnostic Criteria.
- Applied survey-weighted logistic and linear regression to assess associations between AD status and cardio-metabolic endpoints.
Main Results:
- Identified varying prevalence of AD based on diagnostic criteria (4.8% self-reported physician-diagnosed, 9.4% UK 2/4, 2.3% UK 3/4).
- Observed heterogeneity in cardio-metabolic risk factors across different AD diagnostic groups, including obesity prevalence.
- Populations identified by different criteria were not comparable regarding cardio-metabolic risk factors.
Conclusions:
- No definitive conclusions on cardio-metabolic risk in adults with AD could be drawn due to population heterogeneity and lack of a gold standard.
- The study underscores challenges in questionnaire-based epidemiological research for AD.
- Highlights the critical need for improved definitions and diagnostic standards for atopic dermatitis in population studies.
Background:
The association between atopic dermatitis (AD) and cardio-metabolic risk factors is not yet established. Furthermore, no validated questionnaire-based method of identifying adults with AD is currently available.
Objectives:
To assess the cardio-metabolic risk in adults with a history of AD using 3 different questionnaire-based diagnostic criteria.
Methods:
We utilized data from a general population study including questionnaire data and objective measurements of 9656 Danish adults. To identify adults with a history of AD, we used a question regarding physician-diagnosed AD and 2 versions of the UK Working Party Diagnostic Criteria. Associations between AD status and cardio-metabolic endpoints were estimated using survey weighted logistic and linear regression analysis.
Results:
We identified 462 (4.8%) adults with self-reported physician-diagnosed AD, whereas 903 (9.4%) and 226 (2.3%) had AD according to the UK Working Party Criteria when at least 2 and 3of 4 minor criteria were fulfilled. The populations were not comparable in terms of occurrence of cardio-metabolic risk factors. For example, the prevalence of obesity was lower in participants with physician-diagnosed AD but overall higher in UK 2/4 and UK 3/4.
Conclusion:
Due to the heterogeneity in the captured study populations in terms of the studied outcomes and absence of a gold standard, no conclusions regarding the cardio-metabolic risk in adults with AD in a general population could be made. This study serves as an example of the challenges that are often encountered in questionnaire-based epidemiologic studies and highlights the need of better definitions for this patient group.
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