Long-term socioeconomic outcomes in Danish children with moderate-to-severe atopic dermatitis

The long-term socioeconomic impact of atopic dermatitis (AD) is poorly understood.

To examine if childhood AD is associated with labor market and relationship outcomes in adulthood.

This nationwide registry-based Danish cohort study included children born between 1973 and 1991: 8409 with hospital-diagnosed AD before age 18 (baseline) and 853,228 without. A sibling cohort (5119 with AD; 6352 without) was used to control for family-related confounding. The main outcomes were earned income, long-term unemployment, single partnership status and childlessness by age 30. We used linear regression for income and Poisson regression for binary outcomes, adjusted for income, sex, calendar year, comorbidities and childhood socioeconomic status.

Children with AD had slightly lower income (adjusted mean percentile difference - 1.2) and higher risk of long-term unemployment (adjusted relative risk [aRR] 1.11; 95% CI: 1.05-1.17) by age 30, though the absolute difference was <1%. AD was not associated with secondary labor market outcomes (e.g. health-related work absenteeism), except for disability pension, but the RR decreased from 1.55 to 1.15 (95% CI: 1.02-1.30) when adjusting for comorbidities. By age 30, 22.1% with AD remained single versus 19.4% without (aRR 1.11; 95% CI: 1.06-1.15), with stronger associations among males, those with severe eczema, hand/contact dermatitis or low maternal education (aRRs up to 1.41). AD was not associated with childlessness at age 30 (57.7% vs. 56.7%; aRR 1.01; 95% CI: 1.00-1.03), but a 2.5% absolute difference appeared by age 40. In the sibling analysis, most associations diminished.

Moderate-to-severe childhood AD was not linked to labor market outcomes, apart from disability pensions, likely driven by comorbidities. The probability of partnership or parenthood was reduced in specific subgroups. Confounding from family-related factors cannot be excluded. Nevertheless, the results underscore the importance of considering patients' broader life situations to support them through adulthood.