The Prevalence and Persistence of Atopic Dermatitis in Urban US Children

To examine the association of atopic dermatitis (AD) prevalence and persistence and the relationship between AD persistence and development of asthma.

The authors analyzed data from the Fragile Families and Child Wellbeing Study, a prospective cohort study on 4898 women and their children in 20 large US cities.

Baseline in person interviews were conducted at the child’s birth with follow-up telephone or household interviews at 1, 3, 5, 9 and 15 years of age. History of AD in past year was assessed at the 5, 9 and 15-year follow-up interviews. History of ever having asthma was assessed at the 1-, 3-, 5-, 9-, and 15-year follow-up interviews. AD was classified as early (5 years of age), intermediate (9 years) or late (15 years) based on the first year in which AD was reported. Persistence was classified by the number of years in which AD was reported – transient was on a single year, resolving as reported at 5 and 9 but not 15 years and early onset persistent was reported all 3 years.

3784 children were included at 5 years, 3630 at 9 years and 3580 at 15 years. AD prevalence was 15%, 15.1% and 14.5% at each of these years. Female sex (adjusted OR 1.56; 95% CI, 1.02–2.37) and Black race (adjusted OR 1.80; 95% CI, 1.07–3.01) were associated with persistent AD across all 3 ages. Children with AD at ages 5 and 9 (early resolving AD) had highest odds of ever having asthma (aOR 6.05; 95% CI, 5.88–6.22), followed by AD at 5, 9 and 15 (early persistent AD) (aOR 3.17; 95% CI, 3.07–3.27). Among children with early-onset persistent AD, asthma was significantly increased in those of white (aOR 8.30; 95% CI, 7.21–9.56) and Black (aOR 17.64; 95% CI, 16.73–18.61), but not Hispanic race.

Urban children in the US have a high prevalence and more persistent AD, especially in females, Black and multiracial/other races. Persistent AD was associated with poor quality of life and increased odds of asthma.

This was an interesting study looking not just at prevalence, but also at persistence of AD. The authors found that persistent AD was associated with a higher risk of asthma and a poorer health-related quality of life. Could more aggressive care and better control of early AD decrease the risk of subsequent asthma and improve quality of life? Another study we would love to see.