Severe, active atopic eczema ups risk of death

Adults with severe or predominantly active atopic eczema suffer from heightened all-cause and cause-specific death risks, a recent study has found.

The researchers enrolled 526,736 patients (median age, 41.8 years) with atopic eczema who were followed for a median of 4.5 years. Three atopic eczema severity categories were used (mild, moderate, or severe). A population control group of 2,567,872 individuals without atopic eczema was also included.

Patients were also split into three activity groups, according to disease manifestation during the first 12 months of follow-up: no active atopic eczema, active disease for <50 percent, and active disease for ≥50 percent during the first year.

In the overall study sample, there was only a slight interaction between atopic eczema and all-cause mortality (hazard ratio [HR], 1.04, 99 percent confidence interval [CI], 1.03–1.06). In absolute terms, the risk of death was present but modest (mortality-attributable risk, 62 per 100,000 person-years).

Stratification according to causes of death showed that digestive diseases (HR, 1.11, 99 percent CI, 1.03–1.19) drove the overall mortality risk. Deaths from infections and diseases of the genitourinary system were not related to atopic eczema.

However, when grouping according to disease characteristics, the researchers found a strong interaction between atopic eczema and death. Patients with severe disease, for example, suffered from an almost three-fold increase in the risk of mortality due to infections (HR, 2.85, 99 percent CI, 1.78–4.55).

In addition, all-cause mortality risk in those with severe atopic eczema jumped by more than 50 percent (HR, 1.62, 99 percent CI, 1.54–1.71). A similar pattern was reported for disease activity, such that overall and cause-specific mortality risks were significantly elevated in those with ≥50 percent active disease.