The Association Between Atopic Dermatitis and Select Disease Events in Adults in the United States: A Retrospective Cohort Study in the Optum Electronic Health Records Database.
Adina R Lemeshow, Alexander Egeberg, Thomas Edwards, Stephen E Schachterle, William Romero, Daniela E Myers, Shefali Vyas, Jonathan I Silverberg
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引用次数: 0
Abstract
Introduction: Previous studies have reported positive associations between atopic dermatitis (AD) and select disease events; however, definitive conclusions are lacking. The aim of this study was to characterize demographic and clinical characteristics of patients with and without AD and estimate crude incidence rates (IRs) and adjusted hazard rate ratios (HRRs) of select disease events in these cohorts.
Methods: This retrospective observational analysis used Optum® Market Clarity Electronic Health Records, a US administrative healthcare database. Adults with and without AD between 2016 and 2021 with ≥ 12 months of database activity prior to index date (based on diagnosis or first treatment) were included. Each patient with AD was matched on age and index date with five patients without AD. The AD cohort was stratified by treatment prescribed within 30 days of AD diagnosis: no AD treatment; topical corticosteroids (TCS)/topical calcineurin inhibitors (TCI) only ("TCS/TCI only"); phototherapy with/without TCS/TCI ("phototherapy"); and systemic therapy, including oral corticosteroids with/without phototherapy and with/without TCS/TCI ("systemics"). Crude IRs and adjusted HRRs of infections, malignancies, cardiovascular events, mental health outcomes, asthma, fracture, and death across patient subgroups were estimated.
Results: The total cohort comprised 161,646 adults. Among the 25,915 patients with AD, 8384 (32.35%), 13,459 (51.94%), 366 (1.41%), and 3706 (14.30%) were included in the "no AD treatment," "TCS/TCI only," "phototherapy," and "systemics" subgroups, respectively. Crude IRs/1000 patient-years were higher among patients with AD versus those without AD for serious infections (38.35 vs. 19.21), major adverse cardiovascular events (16.51 vs. 11.82), venous thromboembolism (11.12 vs. 6.89), malignancies (excluding nonmelanoma skin cancer; 17.51 vs. 15.25), and depression (63.50 vs. 44.18); similar trends were observed after controlling for potential confounding variables. When stratified by treatment, IRs and HRRs of these events were generally higher in patients in the "systemics" subgroup versus other treatment subgroups.
Conclusions: Overall, certain disease event rates were higher in the population with AD versus the population without AD, with a trend towards higher rates among patients prescribed systemic therapies compared with those prescribed TCS/TCI only. This study further informs the relationship between AD and the risk of select disease events.
先前的研究报道了特应性皮炎（AD）与某些疾病事件之间的正相关；然而，尚无明确的结论。本研究的目的是描述AD患者和非AD患者的人口学和临床特征，并估计这些队列中选定疾病事件的粗发病率（IRs）和调整危险率比（HRRs）。方法：回顾性观察分析使用Optum®市场清晰度电子健康记录，这是一个美国行政卫生保健数据库。纳入了2016年至2021年间患有或未患有AD的成年人，在索引日期（基于诊断或首次治疗）之前数据库活动≥12个月。每个AD患者在年龄和索引日期上与5名非AD患者相匹配。根据AD诊断后30天内规定的治疗方法对AD队列进行分层：未进行AD治疗；仅限局部皮质类固醇(TCS)/局部钙调磷酸酶抑制剂（TCI）（“仅限TCS/TCI”）；使用/不使用TCS/TCI的光疗（“光疗”）；以及全身治疗，包括口服皮质类固醇伴/不伴光疗和伴/不伴TCS/TCI（“全身治疗”）。对患者亚组的感染、恶性肿瘤、心血管事件、心理健康结局、哮喘、骨折和死亡的粗ir和调整hrr进行估计。结果：整个队列包括161646名成年人。在25915例AD患者中，分别有8384例（32.35%）、13459例（51.94%）、366例（1.41%）和3706例（14.30%）患者被纳入“无AD治疗”、“仅TCS/TCI”、“光疗”和“全身”亚组。在严重感染（38.35 vs. 19.21）、主要不良心血管事件（16.51 vs. 11.82）、静脉血栓栓塞（11.12 vs. 6.89）、恶性肿瘤(不包括非黑色素瘤皮肤癌；17.51 vs. 15.25)，抑郁（63.50 vs. 44.18）；在控制了潜在的混杂变量后，观察到类似的趋势。当按治疗分层时，“全身”亚组患者的ir和hrr通常高于其他治疗亚组。结论：总体而言，AD患者的某些疾病事件发生率高于非AD患者，并且与仅使用TCS/TCI的患者相比，使用全身治疗的患者有更高的发病率趋势。这项研究进一步揭示了AD与特定疾病事件风险之间的关系。
期刊介绍：
Dermatology and Therapy is an international, open access, peer-reviewed, rapid publication journal (peer review in 2 weeks, published 3–4 weeks from acceptance). The journal is dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of dermatological therapies. Studies relating to diagnosis, pharmacoeconomics, public health and epidemiology, quality of life, and patient care, management, and education are also encouraged.
Areas of focus include, but are not limited to all clinical aspects of dermatology, such as skin pharmacology; skin development and aging; prevention, diagnosis, and management of skin disorders and melanomas; research into dermal structures and pathology; and all areas of aesthetic dermatology, including skin maintenance, dermatological surgery, and lasers.
The journal is of interest to a broad audience of pharmaceutical and healthcare professionals and publishes original research, reviews, case reports/case series, trial protocols, and short communications. Dermatology and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an International and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of quality research, which may be considered of insufficient interest by other journals. The journal appeals to a global audience and receives submissions from all over the world.
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