Association of family structure with atopic dermatitis in US children

Early exposure to maternal stress and risk for atopic dermatitis in children: A systematic review and meta-analysis

BACKGROUND

The incidence of atopic dermatitis (AD) in children is increasing. Early exposure to stress factors may be associated with the AD development. This study aimed to summarize studies that reported an association between stress exposure and AD development in later life.

METHODS AND FINDINGS

A comprehensive literature search was performed using online databases (PubMed, EMBASE, PsycINFO, and Web of Science) for articles published up to May 1, 2023. Eligible studies were screened and selected based on the inclusion criteria. We incorporated cohort or case-control studies published in English which explored the relationship between stress experienced by parents or children and AD. The pooled odds ratio (OR) was calculated according to the type of stress using a random-effects model. Twenty-two studies were included. AD was related to maternal distress (OR 1.29, 95% Confidence Interval [CI]: 1.13-1.47), maternal anxiety (OR 1.31, 95% CI: 1.18-1.46), and negative life events (OR 2.00, 95% CI: 1.46-2.76). Maternal depression during pregnancy was associated with AD (OR 1.21, 95% CI: 1.09-1.33), whereas no significant association was found for postpartum depression. Research on stress experienced by paternal or children is scare.

CONCLUSIONS

Early maternal stress may potentially elevate the risk of AD in their offspring. Importantly, rigorously designed studies are required to corroborate the link between maternal stress and AD in children. These studies should aim to gather insights about the impact of stress during specific trimesters of pregnancy, postnatal stress, and paternal stress, and to identify potential prevention strategies.

A systematic scoping review of racial, ethnic, and socioeconomic health disparities in pediatric dermatology

BACKGROUND/OBJECTIVES

Health disparities encompass a wide range of personal, societal, environmental, and system-based factors that contribute to inequitable health and health outcomes in vulnerable patient populations. The goal of this work was to scientifically summarize the existing published North American research on disparity as it pertains to pediatric dermatology.

METHODS

A systematic review was performed according to PRISMA guidelines. A medical librarian performed electronic searches from multiple electronic databases from their dates of inception to March 2021. Title and abstracts were reviewed by authors, identifying articles for full review. Data on article characteristics and identified disparities were then extracted and collected in a spreadsheet.

RESULTS

Fifty-one articles met final inclusion criteria, of which 25 highlighted disparities due to race/ethnicity, 13 highlighted disparities due to socioeconomic (SES), and 13 highlighted disparities due to both race/ethnicity and SES. The most frequent study designs were cross-sectional or survey, followed by retrospective cohort. Only two were prospective cohort studies. Disparities reported included reduced access to care and medications, increased school absenteeism, reduced knowledge about skin care including sun protection, increased hospitalizations and emergency department visits, and severe and persistent disease in the setting of minority race and poverty, among other indicators.

CONCLUSIONS

There are few, scattered research studies addressing disparity in pediatric dermatology. Greater focus will be needed in the future to improve knowledge of sources of disparity and its detrimental effects on the health of children, to rectify the notable disparity under-reporting of disparity research.

Barriers to healthcare access in pediatric dermatology: A systematic review

Barriers to healthcare access are healthcare inequities that have been widely studied across different medical specialties. No studies have previously evaluated the state of barriers to healthcare access research in pediatric dermatology. A systematic review was conducted to examine the types of barriers identified within pediatric dermatology literature. Relevant information was extracted and categorized into the themes of systemic, sociocultural, or individual barriers. The systemic barriers we found include finances, wait times, and geography. The sociocultural barriers included culture beliefs and communication. Patient beliefs and health knowledge were found as individual barriers. The small number and limited scope of studies we identified suggest that barriers to healthcare access in pediatric dermatology remain an understudied topic. Additional research is needed to further characterize these barriers to dermatologic care, as well as the impact of any interventions designed to overcome them.

Association between atopic dermatitis and headaches throughout childhood and adolescence-A longitudinal birth cohort study

BACKGROUND/OBJECTIVES

Atopic dermatitis (AD) is associated with sleep disturbance, psychosocial distress, anxiety, depression, and atopic comorbidities, which may be associated with increased headaches. Our objective was to understand the association of AD and comorbid asthma, sleep and mental health disturbances with headaches throughout childhood and adolescence.

METHODS

Data were analyzed from The Fragile Families and Child Wellbeing Study, a longitudinal birth cohort study of 4898 urban children born in 1998-2000.

RESULTS

AD was associated with headaches at age 5 (adjusted odds ratio [95% confidence interval]: 2.14 [1.27-3.59]), 9 (1.69 [1.27-2.27]) and 15 years (1.71 [1.37-2.14]). AD at age 9 was associated with higher odds of subsequent headaches at age 15 (1.36 [1.05-1.76]). Children with AD at two (1.60 [1.12-2.29]) or all three (1.79 [1.16-2.75]) study-waves had higher odds of headaches at age 15 years. In multivariable repeated measures logistic regression models, significant two-way interactions were found for AD with sleep disturbance (4.59 [3.15-6.69]), attention deficit (hyperactivity) disorder (2.85 [1.87-4.35]), asthma (2.87 [2.18-3.76]), anxiety (2.47 [1.76-3.48]) or depression (2.86 [1.89-4.34]) as predictors of headaches.

CONCLUSION

Children and adolescents with AD, particularly those with sleep disturbances, atopic and mental health comorbidities, had increased headaches. Persistent childhood AD was associated with headaches in adolescence.

Single-parenthood and health conditions among children receiving public assistance in Japan: a cohort study

Background

Children’s healthy development is important. While governmental public assistance benefits financially troubled families, it cannot compensate for a lack of social support. Single-parenthood is a health risk factor for children owing to low-income-associated food insecurity and stress. No study has investigated the association between single-parenthood and health status in children from families receiving public assistance. This study aimed to examine the association between single-parent households and children’s health among public assistance recipients in Japan by using linkage data of two municipal public assistance databases and administrative medical assistance data.

Methods

We performed a retrospective cohort study. Public assistance for households below the poverty line ensures income security and medical care. The study population included all children aged 15 or younger availing public assistance in January 2016. We extracted recipients’ sociodemographic factors from January 2016 and identified the incidence of childhood diseases’ diagnosis until December 2016 as the outcome, including 1) acute upper respiratory infections; 2) influenza and pneumonia; 3) injuries, including fractures; 4) intestinal infectious diseases; 5) conjunctivitis; 6) asthma; 7) allergic rhinitis; 8) dermatitis and eczema, including atopic dermatitis; and 9) diseases of the oral cavities, salivary glands, and jaws, such as tooth decay or dental caries.

Results

Among the 573 children, 383 (66.8%) lived in single-parent households. A multivariable Poisson regression, with a robust standard error estimator, showed that single-parenthood is associated with a higher prevalence of asthma (incidence ratio [IR] = 1.62; 95% confidence interval [CI], 1.16–2.26), allergic rhinitis (IR = 1.41; 95% CI, 1.07–1.86), dermatitis and eczema (IR = 1.81; 95% CI, 1.21–2.70), and dental diseases (IR = 1.79; 95% CI, 1.33–2.42) compared to non-single parent households, whereas little association was found between single-parenthood and children’s acute health conditions.

Conclusions

Among public assistance recipients, living in single-parent households may be a risk factor for children’s chronic diseases. The Japanese public assistance system should provide additional social care for single-parent households. Further investigations are necessary using more detailed longitudinal data, including environmental factors, the severity of children’s health conditions, contents of medical treatments, and broader socioeconomic factors.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-021-02682-4.

Secular trends of atopic dermatitis and its comorbidities in United States children between 1997 and 2018

Previous studies found increased prevalence of childhood atopic dermatitis (AD) in the United States over the past few decades. It is unknown whether the prevalence of AD has plateaued or whether AD comorbidities changed over time. The main objective of this study is to assess the prevalence and secular trends of AD and its comorbidities. We analyzed data on 259,818 children, ages 0 to 17 years, from the National Health Interview Survey, 1997-2018, using logistic regression models. The prevalence (95% confidence interval) of childhood AD steadily increased from 2000 [7.3% (6.8-7.9%)] to 2011 [12.8% (12.1-13.5%)] and remained consistent until 2018 [12.6% (11.6-13.5%)]. In logistic regression models, the odds of AD were significantly increased in all years from 2003 to 2018 compared to 1997. However, the increased odds of AD over time were attenuated when adjusting for socio-demographic factors. AD prevalence increased in most socio-demographic groups, but changed variably by age group, race/ethnicity, and region. There were significant trends of AD comorbidities over time, with increasing prevalence of attention deficit (hyperactivity) disorder, and decreasing prevalence of hay fever and depression/sadness. AD prevalence in US children increased between 1997 and 2011, remaining consistent until 2018 with an overall increase of 59%. Prevalence of comorbid hay fever and sadness/depression decreased, while ADD/ADHD increased. Given divergent trends of AD prevalence by socio-demographic characteristics, future studies are better equipped to identify contributing factors of prevalence change.

Atopic dermatitis and psychosocial comorbidities - What's new?

Atopic dermatitis (AD) is a chronic inflammatory disease. During the last years, researchers have focused on a variety of associated comorbidities, especially psychosocial disease. This article aims at giving an overview over recent data. A systematic literature research was performed in PubMed including data from the time period January 1, 2018 until March 1, 2020. Patients with AD frequently suffer from cocomitant depression, anxiety, and attention deficit hyperactivity disorder. There is less evidence about the relation between AD and schizophrenia, eating disorder, and obsessive compulsive disorder. There is still great need for research in the connection between AD and psychosocial disease, particularly about the pathogenesis and the influence of new therapies.

Sociocultural Influences on Disparities in United States Children with Atopic Dermatitis: A Narrative Review of the Literature

Approximately 13% of United States (US) children have atopic dermatitis (AD), also known as eczema. AD is a chronic skin condition associated with significant burdens on quality of life and both individual and overall health-care system costs. The pathogenesis of AD is considered to be multifactorial, with biologic factors such as family history and genetics often reported as influencing risk. Some lesser discussed determinants of AD prevalence and severity are sociocultural, such as race/ethnicity, neighborhood, housing type, income level, and family structure. While several factors appear to contribute to disparities in childhood AD, black or African American race/ethnicity most significantly predicts AD prevalence, severity, disease control, access to care, and family impact. There is a shortage of research related to disparities in AD, an important topic considering the large percentage of families that are affected by the disease. This article is a narrative literature review of sociocultural influences on AD disparities in US children. The purpose of this review is to increase awareness of these important risk factors and to suggest related, future areas of research that may positively impact overall outcomes in children with AD. Much work remains to be done in order to ensure equitable care and outcomes among all children with AD.

Maternal Depression and Atopic Dermatitis in American Children and Adolescents

Atopic dermatitis (AD) is a chronic, inflammatory skin disease associated with considerable burden and mental health symptoms. We sought to determine the association of maternal depression in the postpartum period and maternal and paternal depression in later childhood with AD prevalence and persistence in US children. Data were analyzed from the Fragile Families and Child Wellbeing Study, a prospective cohort study of 4898 children born in 20 metropolitan US cities. History of postpartum depression was associated with childhood AD overall (multivariable logistic regression; adjusted odds ratio [aOR], 1.32; 95% confidence interval [CI], 1.06-1.64), and particularly at ages 5 years (aOR, 1.34; 95% CI, 1.04-1.73) and 9 years (aOR, 1.37; 95% CI, 1.10-1.70). Postpartum depression was associated with more persistent AD (present at 2 years: aOR, 1.58; 95% CI, 1.12-2.22; 3 years: aOR, 1.73; 95% CI, 1.15-2.60). Maternal depression in the past year was associated with significantly higher odds of AD at age 5 years (aOR, 1.54; 95% CI, 1.20-1.99), 9 years (aOR, 1.36; 95% CI, 1.10-1.71), and 15 years (aOR, 1.43; 95% CI, 1.13-1.80). Maternal depression was associated with higher odds of AD during 1 year (aOR, 1.50; 95% CI, 1.16-1.94), 2 years (aOR, 1.60; 95% CI, 1.16-2.19), or all 3 years of interviews (aOR, 1.61; 95% CI, 1.06-2.45). In conclusion, maternal depression in the postpartum period and beyond is associated with AD throughout childhood and adolescence.

The prevalence and persistence of atopic dermatitis in urban United States children

BACKGROUND

Previous studies found that childhood atopic dermatitis (AD) and asthma are associated with residence in urban areas. However, little is known about the prevalence and determinants of AD in US urban populations and its impact on quality-of-life (QOL) and asthma.

OBJECTIVE

To determine AD prevalence and persistence, sociodemographic predictors thereof, and association with QOL and atopic comorbidities in US urban children.

METHODS

We analyzed data from The Fragile Families and Child Wellbeing Study, a prospective cohort study of 4898 women and their children born in 20 large US cities between 1998 and 2000. AD prevalence was determined at ages 5, 9, and 15 years, and stratified by sex, race/ethnicity, and household poverty income level.

RESULTS

The prevalences (95% confidence interval [CI]) of childhood AD were 15.0% (11.0%-18.9%), 15.1% (11.5%-18.7%), and 14.5% (10.4%%-18.5%) at ages 5, 9, and 15 years, respectively. Female sex (multivariable repeated measures logistic regression; adjusted odds-ratio [95% CI]: 1.56 [1.02-2.37]) and black race (1.80 [1.07-3.01]) were associated with persistent AD across all 3 ages. Children with AD at ages 5 and 15 (2.63 [1.42-4.86]), 5, 8 and 15 (1.47 [1.02-2.12]) and 9 and 15 years (1.61 [1.00-2.60]) had higher odds of poor/fair/good overall health. Children with AD at ages 5 and 9 years had the highest odds of ever having asthma (adjusted odds ratio [95% confidence interval]: 6.05 [5.88-6.22]), followed by children with AD at ages 5, 9, and 15 years (3.17 [3.07%-3.27]).

CONCLUSION

Atopic dermatitis prevalence and persistence were highest in US urban children who were female or black. Urban children with persistent AD were more likely to have poor QOL and asthma.

Predictors of hospital readmission in US children and adults with atopic dermatitis

BACKGROUND

Decreasing readmissions is a health care priority in the United States. However, little is kanown about the determinants of hospital readmissions for atopic dermatitis (AD).

OBJECTIVE

To determine readmission rates among inpatients hospitalized for AD in the United States.

METHODS

We analyzed the 2012-2014 Nationwide Readmission Database, including a representative, cross-sectional sample of hospital readmissions in the United States.

RESULTS

Overall, 17.0% of inpatients with AD were readmitted within 1 year for all causes, including 12.5% with only a single readmission and 4.6% for AD. In multivariable Cox proportional hazards regression models, hospital readmission for AD was associated with below-median household income, being uninsured, having a prolonged initial hospitalization, but inversely associated with older age and a diagnosis of infection. Inpatients admitted for AD on a weekend, in the summer, or in autumn were more likely to be readmitted for AD. Hospital characteristics associated with readmission for AD included nonmetropolitan hospital location and hospital teaching status.

CONCLUSION

One in 5 inpatients with AD are readmitted within 1 year for all causes. There are socioeconomic and health care disparities in readmission rates for AD.

Associations of unsafe, unsupportive, and underdeveloped neighborhoods with atopic dermatitis in US children

BACKGROUND

Atopic dermatitis (AD) is influenced by multiple emotional and environmental factors. Yet, little is known about the impact of neighborhood environment characteristics on AD.

OBJECTIVE

To determine the association of neighborhood characteristics with AD prevalence and severity in US children.

METHODS

We analyzed data from the 2007-2008 National Survey of Children's Health, including a representative sample of 79,667 children and adolescents (age 0-17 years) in the United States. Multivariable weighted logistic regression models that adjusted for sociodemographics were constructed to determine the associations of neighborhood characteristics with AD prevalence and severity.

RESULTS

Atopic dermatitis prevalence or severity were significantly increased in children residing in neighborhoods where people reportedly definitely do not help each other out (adjusted odds ratio [95% confidence interval]: 1.32 [1.15-1.52]), watch out for each other's children (1.26 [1.10-1.45] and 1.66 [1.14-2.41], respectively), have people to count on (1.28 [1.13-1.45]), and trusted adults to help the child (1.16 [1.01-1.32] and 1.54 [1.05-2.27], respectively). Children also had increased odds of AD if their caregiver felt that the child was never (1.52 [1.27-1.82]) or sometimes (1.23 [1.12-1.36]) safe in his/her neighborhood. Severe AD was less common in children residing in a neighborhood with a bookmobile or library (0.68 [0.52-0.90]).

CONCLUSION

US children residing in unsafe, unsupportive, or underdeveloped neighborhoods have higher prevalence and severity of AD.