Prevalence estimates for chronic urticaria in the United States: A sex- and age-adjusted population analysis

BACKGROUND

Disease burden in chronic urticaria (CU) is poorly understood.

OBJECTIVE

To estimate standardized overall and sex-, age-, and race-specific prevalence estimates for CU among adults in the United States.

METHODS

A cross-sectional analysis with electronic health records data for a demographically heterogeneous population-based sample of >55 million patients across all 4 census regions.

RESULTS

The overall CU prevalence was 0.23%, or 230 CU cases/100,000 adults. The adjusted prevalence in women was 310 (95% confidence interval [CI] 307-312) cases/100,000 adults, more than twice that of men (146 [95% CI 143-148] cases/100,000 adults, P < .001). CU prevalence was highest among patients aged 40-49 years (256 [95% CI 252-261] cases/100,000 adults) and 50-59 years (246 [95% CI 242-251] cases/100,000 adults) compared with all other age groups (P < .0001). Adjusted prevalences for black (292 [95% CI 285-298] cases/100,000 adults) and other (331 [95% CI 323-338] cases/100,000 adults) patients were higher than that for white patients (262 [95% CI 260-264] cases/100,000 adults; P < .001).

LIMITATIONS

Use of administrative data has the potential to underestimate burden.

CONCLUSION

There are >500,000 people estimated to have CU in the United States, most of whom are women or adults ≥40 years of age.

Overall and subgroup prevalence of acne vulgaris among patients with hidradenitis suppurativa

BACKGROUND

Evidence establishing a link between acne vulgaris (AV) and hidradenitis suppurativa (HS) is limited, and the burden of AV in adults with HS is unknown.

OBJECTIVE

To determine the prevalence of AV among adults with HS and determine the strength of this association.

METHODS

Cross-sectional analysis identifying adults with AV among patients with and without HS by using electronic health record data from a population-based sample of more than 55 million patients.

RESULTS

The prevalence of AV among adults with HS was 15.2% (7315 of 48,085) compared with 2.9% (497,360 of 16,899,470) for adults without HS (P < .001). The prevalence was greatest among patients with HS who were female (5870 of 35,790 [16.4%]), were 18 to 44 years old (5260 of 28,870 [18.2%]), were nonwhite (3120 of 17,825 [17.5%]), were obese (5430 of 35,135 [15.5%]), and had polycystic ovarian syndrome (685 of 2385 [28.7%]). Patients with HS had 4.51 [95% confidence interval, 4.40-4.63] times the odds of having AV than did patients without HS, with the higher likelihood of having AV persisting across all subgroups of patients with HS. The association between HS and AV was generally stronger for patients who were male, and 65 years of age or older.

LIMITATIONS

Influence of disease severity in HS, or in acne, on the strength of the association could not be assessed.

CONCLUSION

Patients with HS may benefit from assessment of acne status and optimization of comanagement strategies.

Prevalence estimates for pemphigoid in the United States: A sex-adjusted and age-adjusted population analysis

BACKGROUND

The burden of the pemphigoid group of autoimmune blistering diseases is poorly understood.

OBJECTIVE

To estimate standardized overall and sex-specific, age-specific, and race-specific prevalence estimates for pemphigoid among adults in the United States.

METHODS

Cross-sectional analysis of electronic health records data for a demographically heterogeneous population-based sample of >55 million patients across all 4 census regions.

RESULTS

Overall pemphigoid prevalence was 0.012%, or 12 pemphigoid patients/100,000 adults. Prevalence of pemphigoid among those aged ≥60 years was 0.038%, or 37.7 cases/100,000 adults. Prevalence increased ∼2-fold within each successive age group and was highest among patients aged ≥90 years (123.6 [95% CI 115.2-132.5] cases/100,000 adults). Adjusted prevalence in women was 12.7 (95% CI 12.3-13.2) cases/100,000 adults, slightly more than that in men (11.0 [95% CI 10.5-11.6] cases/100,000 adults). Adjusted prevalences were similar for blacks (15.4 [95% CI 14.0-17.0] cases/100,000 adults) and whites (13.5 [95% CI 13.0-13.9] cases/100,000 adults).

LIMITATIONS

Analysis of electronic health data might result in disease misclassification.

CONCLUSION

Pemphigoid is rare in the United States. Patients aged ≥60 years comprise the majority of cases.

Exposure to bisphenols and phthalates and association with oxidant stress, insulin resistance, and endothelial dysfunction in children

BACKGROUND

The health effects of bisphenol A (BPA) and di-(2-ethylhexyl) phthalate (DEHP) have been studied extensively in children. The impact of other chemicals in these two classes has not been investigated as fully.

METHODS

We conducted a cross-sectional pilot study of 10-13 y old healthy children. We assessed descriptive, univariable, and multivariable associations of urinary metabolites of bisphenols and phthalates with oxidant stress, insulin resistance, body mass, and endothelial dysfunction. Possible associations with brachial artery distensibility, pulse wave velocity (markers of vascular stiffness), and serum endothelial cell-derived microparticle levels were also assessed.

RESULTS

We enrolled 41 participants, 12.1 ± 1.0 y, most of whom were Mexican Americans (42%) or other Hispanics (34%). Increased BPA levels were associated with increased levels of F2-isoprostane (ng/ml) (P = 0.02), with a similar trend for DEHP metabolites. Each log unit increase of high molecular weight (HMW) phthalate metabolites was associated with a 0.550 increase in Homeostatic Model Assessment of insulin resistance (HOMA-IR) units (P = 0.019) and altered circulating levels of activated endothelial cell-derived microparticles (% per ml) (P = 0.026). Bisphenol S (BPS), a replacement for BPA, was associated with increased albumin (mg):creatinine (g) ratio (P = 0.04). Metabolites of HMW phthalates were also associated with decreased brachial artery distensibility (P = 0.047).

CONCLUSION

Exposure to bisphenols and phthalates, including a BPA replacement, is associated with increased oxidant stress, insulin resistance, albuminuria, as well as disturbances in vascular function in healthy children.

Restless Legs Syndrome in Pediatric Patients With Nephrotic Syndrome

Background. Restless legs syndrome (RLS) is a sleep disorder characterized by an urge to move or the presence of unpleasant sensations in the extremities. The prevalence of RLS is higher in children and adults with chronic kidney disease and in adults with glomerular disease. Objective. To determine the prevalence of RLS in children with nephrotic syndrome. Methods. We studied 50 children with nephrotic syndrome and 22 controls. The following surveys were administered: Pediatric Emory RLS questionnaire, Pediatric Daytime Sleepiness Scale, and Pediatric Sleep Questionnaire. Results. Children with nephrotic syndrome were 9.0 ± 4.4 years old, 27 were male, and 27 were in remission. The prevalence of RLS was similar in the nephrotic syndrome cases and controls, whether or not indeterminate cases were considered positive: 14.0% versus 13.6% including indeterminate cases, and 8.0% versus 9.1% excluding indeterminate cases. Conclusion. RLS is not more common in children with glomerular disease compared to healthy controls.