Long-term severe non-dermatological outcomes in eczema

Date of ISAC Approval: 
29/06/2016
Lay Summary: 
Eczema affects 20% of children and up to 10% of adults in developed countries. Eczema is a challenging disease causing significant problems for sufferers and their families. The severity of eczema can vary substantially between individuals and within individuals over time. Even in mild eczema, the itch and soreness can affect all aspects of quality of life, including quality and quantity of sleep, poor school attendance, time off work in adulthood and poor self esteem, resulting from visible skin disease. Despite the importance of eczema, basic questions remain unanswered, including who will develop medical problems related to their eczema? There are many reasons why eczema might be associated with worse medical problems. Eczema is associated with changes in the immune system, including inflammation and reduced ability to fight infections. Eczema may also be associated with lifestyle factors, relating to the effect of eczema on quality of life. There is increasing evidence that eczema may be associated with a range of important medical outcomes. This study will take advantage of a large data set that follows many individuals over time to determine if there is an association between eczema and selected adverse outcomes.
Technical Summary: 
The objectives of this study are to use data from Clinical Practice Research Database (CPRD) and Hospital Episodes Statistics to examine associations between eczema and a range of serious medical outcomes which may be associated with inflammation. Identifying people with eczema Populations with eczema will be identified in CPRD using an algorithm currently being developed and validated comprising Read codes and therapies and /or using ICD-10 codes in linked HES data Eczema and medical outcomes Several categories of conditions have been hypothesized to be associated with eczema including psychiatric diseases, cardiovascular diseases, fractures and autoimmune diseases. There is a lack of longitudinal population-based data to support the associations.1-9 We will undertake a series of matched cohort studies assessing associations between eczema and each outcome. Specifically, we will assess the associations with psychological diseases and obesity in children and adults (separately) with eczema compared to individuals without eczema. We will also examine if adults with eczema have higher rates of fractures, lymphopenia and acute cardiovascular outcomes.13,34 We will use time-updated Cox regression to compute hazard ratios with 99% confidence intervals to assess the associations between eczema and each outcome. We will examine the robustness of our results using several sensitivity analyses.
Health Outcomes to be Measured: 
Associations between eczema and psychological diseases Associations between eczema and key medical outcomes
Collaborators: 

Sinead Langan - Chief Investigator - London School Of Hygiene & Tropical Medicine (LSHTM)
Elizabeth Williamson - Collaborator - London School Of Hygiene & Tropical Medicine (LSHTM)
Dr Harriet Forbes - Collaborator - London School Of Hygiene & Tropical Medicine (LSHTM)
Dr Katrina Abuabara - Collaborator - University Of California, San Francisco
Professor Liam Smeeth - Collaborator - London School Of Hygiene & Tropical Medicine (LSHTM)
Morten Schmidt - Collaborator - Aarhus University Hospital
Richard Silverwood - Collaborator - London School Of Hygiene & Tropical Medicine (LSHTM)
Sigrun Alba Johannesdottir Schmidt - Collaborator - Aarhus University Hospital
Sinead Langan - Corresponding Applicant - London School Of Hygiene & Tropical Medicine (LSHTM)

Linkages: 
HES Admitted;Patient IMD;Practice IMD (Standard)