Prevalence of current eczema increasing among children, adolescents
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The prevalence of current eczema increased by 0.98% per decade among adolescents and 1.21% per decade among children over a span of 27 years, according to a study published in Clinical & Experimental Allergy.
However, Sinéad Máire Langan, FRCP, MSc, PhD, professor of clinical epidemiology and Wellcome Trust senior clinical fellow at London School of Hygiene & Tropical Medicine, and colleagues found great variation in these changes globally by income and region.
“The burden of eczema is substantial globally,” Langan told Healio. “In order to help people who currently have eczema and to identify approaches to prevent it, we need to understand the size of the problem around the world and whether the condition is becoming more or less common, including identifying preventative factors.”
Study population, results
The researchers analyzed 2015 to 2020 data from the Global Asthma Network (GAN) Phase I study, including 74,361 adolescents aged 13 to 14 years and 47,907 children aged 6 to 7 years from 27 centers in 14 countries.
The researchers then compared these data with the International Study of Asthma and Allergies in Childhood (ISAAC) Phase I (1993 to 1995) and Phase III (2001 to 2003) datasets.
Adolescents completed questionnaires about their asthma, eczema and rhinoconjunctivitis symptoms at school, whereas caregivers completed questionnaires about these symptoms for their children at home.
The median prevalence of current eczema symptoms was 6.2% among adolescents and 6% among children, with severe eczema symptoms that disturbed sleep showing a median prevalence of 1.1% among adolescents and 0.6% among children.
Current eczema symptom prevalence increased by 0.98% (95% CI, 0.04%-1.92%) for adolescents and 1.21% (95% CI, 0.18%-2.24%) for children per decade.
Also, severe eczema symptoms increased by 0.26% (95% CI, 0.06%-0.46%) for adolescents and by 0.23% (95% CI, 0.02%-0.45%) for children per decade.
Lifetime eczema prevalence increased by 2.71% (95% CI, 1.1%-4.32%) for adolescents and by 3.91% (95% CI, 2.07%-5.75%) for children per decade.
Changes by region, income
However, researchers noted that standard deviations revealed substantial heterogeneity between centers regarding 10-year changes.
“Although the average increase was small over time, we noticed that changes in how common eczema was over time varied greatly and some of this variation could be explained by geographic region and income,” Langan said.
Variations in 10-year changes were based on world region and income group for most outcomes (P .0001) except for severe eczema symptoms by income group.
Africa and the Eastern Mediterranean region drove most of the increases in period and severe eczema symptoms prevalence, whereas Europe and the Americans were responsible for much of the increase in lifetime prevalence among adolescents and children.
Researchers noted that children in high-income countries had 10-year increases in most outcomes, including 2.41% (95% CI, 0.87%-3.95%) for current eczema symptoms, 0.32% (–0.02% to 0.66%) for severe eczema and 7.46% (4.77%-10.14%) for lifetime eczema prevalence. Other income groups did not show as much evidence for change other than
a 5.5% (95% CI, 2.22%-8.78%) change in lifetime prevalence for children in upper-middle income countries.
Adolescents in lower-middle income countries experienced increases of 2.32% (95% CI, 0.4%-4.25%) in eczema symptom prevalence and 0.71% (95% CI, 0.29%-1.14%) in severe eczema symptoms. Those in upper-middle income countries experienced a 3.93% (95% CI, 0.96%-6.89%) increase in lifetime eczema prevalence, with weak evidence for a 1.66% (95% CI, –0.06% to 3.37%) increase in eczema symptom prevalence.
Conclusions, next steps
The researchers suggested that these changes could be attributed to environmental factors, which are complex, or to poor access to treatment. But regardless of their causes, the researchers said, these increases indicate a substantial global burden for eczema.
“Knowing the burden of eczema will help with planning health care services for people with eczema around the world, including increasing awareness of the problem amongst policymakers,” Langan said.
“The variability we saw in changes in how common eczema was over time provide key clues that we will now examine to identify factors that might explain these changes,” she continued. “They will also help identify approaches to help reduce this burden through future prevention.”
For more information:
Sinéad Máire Langan, FRCP, MSc, PhD, can be reached at sinead.langan@lshtm.ac.uk.
Perspective
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The results of this study demonstrate that eczema carries a very high burden of disease globally. Not surprisingly, the extent of this burden is variable across different regions and countries. Interestingly, changes in prevalence over the last few decades also differed.
This study highlights the ongoing need for safe, effective and accessible treatments with such a large population of children and adolescents affected worldwide. The heterogeneity of the epidemiological trends also suggests that further research is needed to better understand the various factors driving changes in prevalence over time so public health initiatives can be implemented alongside medical advances to reduce the burden of this disease.
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