The epidemiology of eczema in children and adults in England: A population-based study using primary care data

Abstract

Background: Whilst eczema is a common inflammatory skin condition, we lack contemporary estimates of disease incidence and prevalence across the lifespan.

Objective: To estimate the incidence and prevalence of eczema in children and adults in England and variation by sociodemographic factors (sex, socio-economic status, ethnicity, and geography).

Methods: We used the Royal College of General Practitioners Research and Surveillance Centre primary care research database of 3.85 million children and adults registered with participating general practitioner practices between 2009 and 2018 inclusive. Eczema incidence was defined as the first-ever diagnosis of eczema recorded in the primary care record, and eczema prevalence was defined as fulfilment of criteria for active eczema (two eczema records appearing in the primary care record within any one-year period).

Results: Eczema incidence was highest in infants younger than 1 year (15.0 per 100 person-years), lowest in adults aged 40-49 (0.35 p/100 person-years), and increased from middle age to a second smaller peak in people 80 years or older (0.79 p/100 person-years). Eczema prevalence was highest in children aged 2 (16.5%) and lowest in adults aged 30-39 (2.8%). Eczema incidence was higher in male infants (<2) and male adults older than 70; for all other ages, incidence was higher in females. Eczema was more common in Asian and black ethnic groups than in people of white ethnicity. Higher socio-economic status was associated with a greater incidence of eczema in infants younger than 2, but the reverse was seen for all other age groups. Both incidence and prevalence of eczema were greater in urban settings and in North-West England.

Conclusions and clinical relevance: Eczema has a bimodal distribution across the lifespan. We observed differences in incidence and prevalence of eczema by ethnicity, geography, sex, and socio-economic status, which varied in magnitude throughout life.

Trial registration: ClinicalTrials.gov NCT03823794.

Keywords: atopic dermatitis; dermatology; eczema; epidemiology; incidence; primary care.

Conflict of interest statement

S. de Lusignan is Director of the Royal College of General Practitioners Research and Surveillance Centre as part of his academic post; he has also received funding for projects from Eli Lilly, AstraZeneca, GSK, Seqirus, and Takeda, all through his universities and none related to this study. C. Feeney is an employee of Pfizer. J. Dennis and A. McGovern are employees of Momentum Data who were paid consultants to Pfizer in connection with the development of this manuscript. C. Flohr is chief investigator of the UK National Institute for Health Research—funded TREAT (ISRCTN15837754) and SOFTER (ClinicalTrials.gov: NCT03270566) trials and the UK‐Irish Atopic Eczema Systemic Therapy Register (A‐STAR; ISRCTN11210918) and is a principal investigator in the European Union Horizon 2020—funded BIOMAP Consortium (http://www.biomap-imi.eu/). His department has also received funding from Sanofi‐Genzyme. All other authors have no competing interests to declare.

© 2020 The Authors. Clinical & Experimental Allergy published by John Wiley & Sons Ltd.

Figures

FIGURE 1

The crude incidence of eczema per 100 person‐years by age and sex in (A) children (n = 913,606) and (B) adults (n = 3,149,160). Grey shading represents 95% confidence intervals

FIGURE 2

Prevalence of eczema by age category and sex in (A) children (n = 570,536) and (B) adults (n = 2,168,805). Grey shading represents 95% confidence intervals

FIGURE 3

The geographical distribution of eczema in England. (A) Adjusted incidence rate ratios (aIRR) for eczema in 2018 by geographical region (n = 2,336,322). aIRR are relative to London. (B) Adjusted odds ratios (OR) for active eczema in 2018 by geographical region (n = 2,742,094). OR are relative to London