Research Highlights All-Cause Mortality Rates in Patients with Concomitant Atopic Dermatitis and Asthma

Recent findings from the Department of Dermatology in Denmark, Copenhagen discovered that adults with atopic dermatitis (AD) had an increased risk of death, especially when the condition was paired with asthma.

The data surrounding atopic dermatitis and asthma were crucial to the findings. According to the study, the prevalence of atopic dermatitis in adults ranges from 2-5%. Asthma, a chronic airways disease, is even more common, affecting 8% of the adult population.

Investigators claimed that overwhelming evidence supports a causal link between asthma and AD, as nearly 25% of all patients with atopic dermatitis also suffer from asthma.

Despite the decline in asthma mortality worldwide, the researchers considered the number of asthma-related deaths to be “disturbingly high.” Additionally, little data exists on the mortality rate for patients with atopic dermatitis or asthma.

In an effort to determine the mortality rate in patients with concomitant AD and asthma compared to patients with only atopic dermatitis or asthma, Zarqa Ali, MD, PhD and colleagues assembled a study cohort of 8095 adults with atopic dermatitis, 1201 of whom also had concomitant asthma.

A background population of 32,380 subjects were also included.

Ali and colleagues obtained data from The National Causes of Death Registry as well as the Danish Registry of Medicinal Products Statistics, which they used to follow patients from the age of 18 until either migration, death, or the end of the investigation on December 21, 2018.

Causes of death featured in the registry included infectious, cardiovascular, pulmonary, gastrointestinal and hepatic, urogenital, psychiatric, and neurologic diseases and more.

Systemic corticosteroid prescriptions, hospital admissions for atopic dermatitis, and emergency room visits and hospital admissions for asthma were used as predictors of mortality in the study, and socioeconomic status was also considered.

A follow-up was conducted with all participants during the study.

The follow-up showed that a totally of 1057 members of the background population (patients neither atopic dermatitis or asthma) died during the study. The researchers went on to record 330

deaths for the atopic dermatitis only group as well as 55 and 99 deaths for the asthma only and concomitant atopic dermatitis and asthma groups, respectively.

The most frequent causes of death in patients in all participant groups were cardiovascular disease and cancer. Pulmonary disease was also prominent in the asthma only group (38.2%).

Additionally, men had an increased risk of death in all groups (though statistically insignificant for the asthma only group).

The findings showed that subjects with neither atopic dermatitis nor asthma tended to have higher mortality rates regarding specific causes such as cardiovascular disease.

However, according to the study the all-cause mortality rate given in incidence rates per 1000 person years was 4.75 (95% CI, 4.47-5.05) for subjects with neither atopic dermatitis nor asthma, 7.17 (95% CI, 5.92-10.05) for asthma only, 7.09 (95% CI 6.37-7.90) for atopic dermatitis only, and 10.87 (95% CI, 8.92-13.23) for concomitant AD and asthma.

These findings suggested a higher overall mortality rate for subjects with concomitant atopic dermatitis and asthma.

Researchers also cited emergency room visits and general hospital admissions for asthma and atopic dermatitis as significant predictors for death, which further increased the risk of death for subjects with concomitant atopic dermatitis and asthma.

The study concluded with the investigators urging for improvements on the management of atopic dermatitis and asthma from health care professionals, as well as future studies on the severity of both diseases.

“Increased focus on development and implementation of early preventative and improved management strategies for patients with concomitant AD and asthma to modify increased risk of mortality is warranted,” the team wrote. “Further, future studies should investigate whether asthma is more severe in patients with concomitant AD and asthma compared to asthma only.”

The study, “Increased all-cause mortality in concomitant atopic dermatitis and asthma: A nationwide registry-based study,” was published online in Clinical & Experimental Allergy