Comorbidities of Atopic Dermatitis: using National Health Insurance data in Korea

ISAD > All Meetings > Other past meetings > ISAD 2020 (live) > Comorbidities of Atopic Dermatitis: using National Health Insurance data in Korea

SESSION 2 / New fields in AD: big data mining, AD in sub-Saharan Africa, neuroinflammation

Jiyoung AHN
National Medical Center, Seoul, Korea
Oregon Health and Science University, OR, USA

Overview

  1. Objective
  2. Methods
  3. Results
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Atopic March ➜ Inflammatory Skin March

➜ worldallergy.org education & programs

Conflicting Results Cardiovascular Risk and Disease

  • direct effect
  • indirect effect

Objective

To analyze whether the risk of other diseases are different between AD patients and healthy controls using National Health Insurance Data in Korea.

Methods

Korean National Health Insurance Research Database

  • Data from 2005 to 2016
    • Healthy control (N=1,331,969)
    • AD patients (N=285,468)
  • Control group matched the age and sex of AD patients
  • AD groups: Non-AD groups ➜ ratio of 1:5
  • Survival Analysis (Multivariable Cox regression)
  • ANOVA test
  • Using SAS, Version 9.4, SAS Institute, Cary, NC

Operation Definition: AD Patients

  • Atopic Dermatitis Code (main)
  • Two AD-Related Test

Validation study to accurately identify patients with atopic dermatitis in the National Health Insurance Data in Korea:

GroupAD codeAD labSensitivitySpecificityPositive predictive valueNegative predictive value
A2–0.030.990.900.52
B110.300.990.960.60
C120.290.990.980.59
D1⩾ 30.110.020.970.54
Table 1. Sensitivity, specificity, positive predictive value, negative predictive value
of each group

Each group was investigated for accompanying

  • Cardiovascular Disease
    • CVD, which contains hypertension, type 2 diabetes, hyperlipidemia, angina, myocardial infarction, peripheral vascular disease, stroke I10, E11, E780~E785, I20, I21, I22, I23, I70, I71, I72, I73, I63, I64
  • Inflammatory Bowel Disease (IBD)
    • K50, K51
  • Allergic Contact Dermatitis (ACD)
    • L23, L25
  • Skin Cancer
    • BCC, SCC, MM, AK, Bowen’s Dis.
    • C443, C449, C000, C001, C441, C442, C443, C445, C446, C447, C449, C435, C436, C439, L570, D049
  • Psoriasis
    • L4

Results

TOTALN%
Total2 780 356100
Male1 379 33649.6
Female1 401 02050.4
Under 10720 29825.9
10s1 071 28638.5
20s451 59516.2
30s257 4079.3
40s132 1984.8
50s77 6372.8
60s43 7811.6
over 7026 1540.9
MODERATEN%
Male29 04950.0
Female29 09950.0
Under 1013 48623.2
10s20 93936.0
20s12 70221.8
30s6 75811.6
40s2 5474.4
50s8361.4
60s4810.8
over 703990.7
SEVEREN%
Total1 140 898
Male567 13149.7
Female573 76750.3
Under 10257 60722.6
10s411 50736.1
20s209 89918.4
30s124 89211.0
40s63 8075.6
50s38 0173.3
60s21 9281.9
over 7013 1511.2

Trend Analysis in the Number of AD Patients by Year

Frequency Analysis

Multivariable Cox Regression Analysis

Multivariable Cox Regression Analysis according to AD Severity

Summary

  • Increase in AD in Korea
  • Increase in AD over 30 years of age indicated that the study of systemic diseases that witch occur mainly in adults, such as CVD, is crucial for AD research.
  • Increase in severe AD should be noted. Because the increase in comorbidities increases according to the severity, more active treatment is required.
  • Skin cancer, psoriasis, CVD, IBD, and ACD than non-AD patients although adjusted by sex, age, and metabolic disorders
  • The results of our study confirmed that AD is associated with CVD after adjusting for other variables, indicating that AD directly affects CVD and metabolic diseases

Limitation

  • Adjustments were made for age and sex, metabolic disorders, and other CVDs, but not for education level, physical activities, medication, obesity (body mass index), smoking, and alcohol intake.
  • It is impossible to accurately determine the causal relationship over time due to the study design, and there may be cases where an incident occurs, which is a problem that most population based studies have in common.
  • well-planned longitudinal prospective cohort study should be conducted to draw a more accurate conclusion.
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Disclosure of conflict of interest:
  • MOU Koean Atopic Dermatitis Association with National Health Insurance Sharing Service
References
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