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Original Investigation
September 1, 2021

Patterns of Atopic Eczema Disease Activity From Birth Through Midlife in 2 British Birth Cohorts

Author Affiliations
  • 1Program for Clinical Research, Department of Dermatology, University of California School of Medicine, San Francisco
  • 2Center for Epidemiology and Biostatistics, Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
  • 3Department of Epidemiology and Biostatistics, University of California School of Medicine, San Francisco
  • 4Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
  • 5Centre for Longitudinal Studies, Social Research Institute, University College London, London, United Kingdom
  • 6Centre of Evidence Based Dermatology, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, United Kingdom
JAMA Dermatol. Published online September 1, 2021. doi:10.1001/jamadermatol.2021.2489
Key Points

Question  Are there patterns of atopic eczema activity that continue into adulthood?

Findings  Among 30 905 participants evaluated from birth into midlife, 4 patterns of activity for atopic eczema were identified across ages: high probability, decreasing, increasing, and low probability. Early life factors did not differentiate the high from the decreasing subtype, and the subtype with increasing probability of activity had the highest risk of poor self-reported health in midlife.

Meaning  The probability of atopic eczema remains high into adulthood for a subgroup of patients but decreases for others; a newly identified subgroup with increasing probability of activity in adulthood warrants additional research.

Abstract

Importance  Atopic eczema is characterized by a heterogenous waxing and waning course, with variable age of onset and persistence of symptoms. Distinct patterns of disease activity such as early-onset/resolving and persistent disease have been identified throughout childhood; little is known about patterns into adulthood.

Objective  This study aimed to identify subtypes of atopic eczema based on patterns of disease activity through mid-adulthood, to examine whether early life risk factors and participant characteristics are associated with these subtypes, and to determine whether subtypes are associated with other atopic diseases and general health in mid-adulthood.

Design, Setting, and Participants  This study evaluated members of 2 population-based birth cohorts, the 1958 National Childhood Development Study (NCDS) and the 1970 British Cohort Study (BCS70). Participant data were collected over the period between 1958 and 2016. Data were analyzed over the period between 2018 and 2020.

Main Outcomes and Measures  Subtypes of atopic eczema were identified based on self-reported atopic eczema period prevalence at multiple occasions. These subtypes were the outcome in models of early life characteristics and an exposure variable in models of midlife health.

Results  Latent class analysis identified 4 subtypes of atopic eczema with distinct patterns of disease activity among 15 939 individuals from the NCDS (51.4% male, 75.4% White) and 14 966 individuals from the BCS70 (51.6% male, 78.8% White): rare/no (88% to 91%), decreasing (4%), increasing (2% to 6%), and persistently high (2% to 3%) probability of reporting prevalent atopic eczema with age. Sex at birth and early life factors, including social class, region of residence, tobacco smoke exposure, and breastfeeding, predicted differences between the 3 atopic eczema subtypes and the infrequent/no atopic eczema group, but only female sex differentiated the high and decreasing probability subtypes (odds ratio [OR], 1.99; 95% CI, 1.66-2.38). Individuals in the high subtype were most likely to experience asthma and rhinitis, and those in the increasing subtype were at higher risk of poor self-reported general (OR, 1.29; 95% CI, 1.09-1.53) and mental (OR 1.45; 95% CI, 1.23-1.72) health in midlife.

Conclusions and Relevance  The findings of this cohort study suggest that extending the window of observation beyond childhood may reveal clear subtypes of atopic eczema based on patterns of disease activity. A newly identified subtype with increasing probability of activity in adulthood warrants additional attention given observed associations with poor self-reported health in midlife.

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