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Different definitions of atopic dermatitis: Impact on prevalence estimates and associated risk factors

Different definitions of atopic dermatitis: Impact on prevalence estimates and associated risk factors
Different definitions of atopic dermatitis: Impact on prevalence estimates and associated risk factors

BACKGROUND: There is no objective test that can unequivocally confirm the diagnosis of atopic dermatitis (AD), and no uniform clinical definition.

OBJECTIVE: To investigate to what extent operational definitions of AD cause fluctuation in the prevalence estimates and the associated risk factors.

METHODS: We first reviewed operational definitions of AD used in the literature. We then tested the impact of the choice of the most common definitions of "Cases" and "Controls" on AD prevalence estimates and associated risk factors (including filaggrin-FLG mutations) among children aged 5 years in two population-based birth cohorts: Manchester Asthma and Allergy Study (MAAS) and Asthma in Ashford. Model performance was measured by the percentage of children within an area of clinical indecision (defined as having a posterior probability of AD between 25% and 60%).

RESULTS: We identified 59 different definitions of AD across 45 reviewed studies. Of those, we chose 4 common "Case" definitions, and 2 definitions of "Controls". The prevalence estimates using different case definitions ranged between 22% and 33% in MAAS, and 12% and 22% in Ashford. The area of clinical indecision ranged from 32% to 44% in MAAS, and from 9% to 29% in Ashford. Depending on the case definition used, the associations with FLG mutations varied (ORs [95% CI]: 1.8 [1.1-2.9] to 2.2 [1.3-3.7] (MAAS) and 1.7 [0.8-3.7] to 2.3 [1.2-4.5] (Ashford)). Associations with FLG mutations also differed when using the same "Case" definition, but different definitions of "Controls".

CONCLUSION: Use of different definitions of AD results in substantial difference in prevalence estimates, the performance of prediction models, and association with risk factors. This article is protected by copyright. All rights reserved.

0007-0963
Nakamura, T.
7e0c5760-b437-4ca5-b5c6-a344b9ff362e
Haider, S.
8f4f1f66-534d-4c15-a297-22994e61beae
Colicino, S.
57553b42-a96e-4380-b78c-467e6a35f8a7
Murray, C.S.
9c493c5d-42ad-430b-92fe-c767d965d833
Holloway, J.
4bbd77e6-c095-445d-a36b-a50a72f6fe1a
Simpson, A.
1c86875e-9e9c-46d4-887c-dca942aec772
Cullinan, P.
dc367687-756e-4bef-af32-8fd2ff2023a7
Custovic, A.
624645ad-f4d2-4b1f-a9b6-a8bd763a8d84
STELAR investigators
Nakamura, T.
7e0c5760-b437-4ca5-b5c6-a344b9ff362e
Haider, S.
8f4f1f66-534d-4c15-a297-22994e61beae
Colicino, S.
57553b42-a96e-4380-b78c-467e6a35f8a7
Murray, C.S.
9c493c5d-42ad-430b-92fe-c767d965d833
Holloway, J.
4bbd77e6-c095-445d-a36b-a50a72f6fe1a
Simpson, A.
1c86875e-9e9c-46d4-887c-dca942aec772
Cullinan, P.
dc367687-756e-4bef-af32-8fd2ff2023a7
Custovic, A.
624645ad-f4d2-4b1f-a9b6-a8bd763a8d84

Nakamura, T., Haider, S., Colicino, S., Murray, C.S., Holloway, J., Simpson, A., Cullinan, P. and Custovic, A. , STELAR investigators (2019) Different definitions of atopic dermatitis: Impact on prevalence estimates and associated risk factors. British Journal of Dermatology. (doi:10.1111/bjd.17853).

Record type: Article

Abstract

BACKGROUND: There is no objective test that can unequivocally confirm the diagnosis of atopic dermatitis (AD), and no uniform clinical definition.

OBJECTIVE: To investigate to what extent operational definitions of AD cause fluctuation in the prevalence estimates and the associated risk factors.

METHODS: We first reviewed operational definitions of AD used in the literature. We then tested the impact of the choice of the most common definitions of "Cases" and "Controls" on AD prevalence estimates and associated risk factors (including filaggrin-FLG mutations) among children aged 5 years in two population-based birth cohorts: Manchester Asthma and Allergy Study (MAAS) and Asthma in Ashford. Model performance was measured by the percentage of children within an area of clinical indecision (defined as having a posterior probability of AD between 25% and 60%).

RESULTS: We identified 59 different definitions of AD across 45 reviewed studies. Of those, we chose 4 common "Case" definitions, and 2 definitions of "Controls". The prevalence estimates using different case definitions ranged between 22% and 33% in MAAS, and 12% and 22% in Ashford. The area of clinical indecision ranged from 32% to 44% in MAAS, and from 9% to 29% in Ashford. Depending on the case definition used, the associations with FLG mutations varied (ORs [95% CI]: 1.8 [1.1-2.9] to 2.2 [1.3-3.7] (MAAS) and 1.7 [0.8-3.7] to 2.3 [1.2-4.5] (Ashford)). Associations with FLG mutations also differed when using the same "Case" definition, but different definitions of "Controls".

CONCLUSION: Use of different definitions of AD results in substantial difference in prevalence estimates, the performance of prediction models, and association with risk factors. This article is protected by copyright. All rights reserved.

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Nakamura_et_al-2019-British_Journal_of_Dermatology - Accepted Manuscript
Restricted to Repository staff only until 1 March 2020.
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e-pub ahead of print date: 1 March 2019
Additional Information: This article is protected by copyright. All rights reserved.

Identifiers

Local EPrints ID: 429155
URI: https://eprints.soton.ac.uk/id/eprint/429155
ISSN: 0007-0963
PURE UUID: 2cef753f-17b8-4652-93dc-a1edaacfc568
ORCID for J. Holloway: ORCID iD orcid.org/0000-0001-9998-0464

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Date deposited: 22 Mar 2019 17:30
Last modified: 23 Mar 2019 01:36

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Contributors

Author: T. Nakamura
Author: S. Haider
Author: S. Colicino
Author: C.S. Murray
Author: J. Holloway ORCID iD
Author: A. Simpson
Author: P. Cullinan
Author: A. Custovic

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