Clinical and Humanistic Burden of Atopic Dermatitis in Europe: Analyses of the National Health and Wellness Survey

Thomas Luger; William A Romero; David Gruben; Timothy W Smith; Amy Cha; Maureen P Neary

doi:10.1007/s13555-022-00700-6

Clinical and Humanistic Burden of Atopic Dermatitis in Europe: Analyses of the National Health and Wellness Survey

Dermatol Ther (Heidelb). 2022 Apr;12(4):949-969. doi: 10.1007/s13555-022-00700-6. Epub 2022 Mar 28.

Authors

Thomas Luger¹, William A Romero², David Gruben³, Timothy W Smith⁴, Amy Cha⁴, Maureen P Neary⁵

Affiliations

¹ Department of Dermatology, University Hospital Münster, University Muenster, Von Esmarchstrasse 58, 48149, Münster, Germany. luger@uni-muenster.de.
² Pfizer Ltd., Surrey, UK.
³ Pfizer Inc., Groton, CT, USA.
⁴ Pfizer Inc., New York, NY, USA.
⁵ Pfizer Inc., Collegeville, PA, USA.

Abstract

Introduction: Atopic dermatitis (AD) is a chronic and relapsing inflammatory skin disease that negatively impacts overall health, quality of life (QoL), and work productivity. Prior studies on AD burden by severity have focused on moderate-to-severe disease. Here, we describe the clinical and humanistic burden of AD in Europe across all severity levels, including milder disease.

Methods: Data were analyzed from the 2017 National Health and Wellness Survey from adult respondents with AD in the EU-5 (France, Germany, Italy, Spain, and the UK). AD disease severity was defined based on self-reported assessments as "mild," "moderate," or "severe" and by Dermatology Life Quality Index (DLQI) severity bands. Self-reported outcomes for AD respondents by severity were assessed using propensity score matching. These outcomes included a wide range of selected medical/psychological comorbidities, overall QoL and functional status (EuroQol 5-Dimensions 5-Level and Short Form-36 version 2 questionnaires), and work productivity and activity impairment (Work Productivity and Activity Impairment questionnaire).

Results: In total, 4208 respondents with AD (mild AD, 2862; moderate AD, 1177; severe AD, 169) and 4208 respondents without AD were included in this analysis. Results showed greater burden across severity levels compared with matched non-AD controls. A higher proportion of respondents with mild-to-moderate AD, defined by DLQI severity bands, reported atopic comorbidities (P < 0.05) and a wide range of cardiac, vascular, and metabolic comorbidities, including hypertension, high cholesterol, angina, and peripheral vascular disease (P < 0.005), compared with non-AD controls. Relative to potential impacts of various medical and psychological burdens, respondents with mild-to-moderate AD reported higher activity impairment than controls (P < 0.0001).

Conclusion: Clinical and humanistic burden was observed in European respondents with AD compared with matched non-AD controls across severity levels, with burden evident even in milder disease, highlighting the importance of improving disease management in early stages of AD.

Keywords: Atopic dermatitis; Disease burden; Eczema; Europe; Quality of life.