Severe or mostly active atopic eczema associated with increased mortality

Published online: January 27, 2021

Atopic eczema is becoming more common globally and affects up to 10% of adults, but few studies have assessed if it is associated with increased risk of death. Atopic eczema is very variable in severity and activity, but no study has examined whether any association between atopic eczema and mortality differs by these characteristics. If atopic eczema is associated with increased mortality, this is important from both a public health and a therapeutic perspective as atopic eczema is common.

In a recent research article in The Journal of Allergy and Clinical Immunology (JACI), Silverwood et al examined whether adults with atopic eczema had greater risk of death, both overall and from specific causes, than adults without atopic eczema in a UK cohort, and whether mortality differed by atopic eczema severity or activity. They conducted a population-based study using data from UK primary care electronic healthcare records from 1998 to 2016 with linked information about hospitalization and deaths. A total of 526,736 individuals with atopic eczema were matched to 2,567,872 individuals without atopic eczema. The median age at entry to the study was 41.8 years and the median duration of follow up was 4.5 years.

Silverwood et al found limited evidence of increased overall mortality in those with atopic eczema (4% increase), but somewhat greater differences (8-14%) for deaths due to infectious, digestive and genitourinary causes. However, they found that mortality risk increased with eczema severity and activity. For example, patients with severe atopic eczema had a 62% increased risk of death compared to those without eczema, with the strongest associations for infectious, respiratory and genitourinary causes.

This study found severe and mostly active atopic eczema to be associated with an increased risk of mortality. It used information captured during routine clinical care and showing associations in such observational studies is not the same as saying eczema causes increased mortality. People with severe atopic eczema deserve thorough health assessments, including preventative approaches. Useful next steps would be to improve our understanding of the likely causes of this increased mortality in severe or mostly active atopic eczema, including assessing whether use of systemic treatments to reduce inflammation can decrease mortality.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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