Joy Wan1,2,3, Nandita Mitra3,4, Stephen R Hooper5, Ole J Hoffstad4, David J Margolis1,3,4. 1. Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia. 2. Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 3. Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia. 4. Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia. 5. Department of Allied Health Sciences, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill.
Abstract
IMPORTANCE: Recent population-based data indicate that atopic dermatitis (AD) is associated with learning disability (LD) in children, but the association between AD severity and LD is unknown. OBJECTIVE: To evaluate the association of AD severity with learning problems in children with AD. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study analyzed data of US participants enrolled in the Pediatric Eczema Elective Registry (PEER) between November 1, 2004, and November 30, 2019. Participants were children aged 2 to 17 years at registry enrollment with physician-confirmed diagnosis of AD and had completed 10 years of follow-up in PEER. EXPOSURES: Atopic dermatitis severity measured by both the Patient-Oriented Eczema Measure (POEM) score and self-report. The POEM scores ranged from 0 to 28, with strata of clear or almost clear skin (0-2), mild (3-7), moderate (8-16), severe (17-24), and very severe (25-28). Self-reported AD severity was categorized as clear skin or no symptoms, mild, moderate, or severe. MAIN OUTCOMES AND MEASURES: Learning disability diagnosed by a health care practitioner, as reported by the participants or their caregivers. RESULTS: Among the 2074 participants with AD (1116 girls [53.8%]; median [interquartile range (IQR)] age, 16.1 [13.9-19.5] years at 10-year follow-up), 169 (8.2%) reported a diagnosis of an LD. Children with an LD vs those without an LD were more likely to have worse AD severity, as measured by the median (IQR) total POEM score (5 [1-10] vs 2 [0-6]; P < .001), POEM severity category (moderate AD: 50 of 168 [29.8%] vs 321 of 1891 [17.0%]; severe to very severe AD: 15 of 168 [8.9%] vs 85 of 1891 [4.5%]; P < .001); and self-report (moderate AD: 49 of 168 [29.2%] vs 391 of 1891 [20.7%]; severe AD: 11 of 168 [6.5%] vs 64 of 1891 [3.4%]; P < .001). In multivariable logistic regression models adjusted for sex, age, race/ethnicity, annual household income, age of AD onset, family history of AD, and comorbid conditions, participants with mild AD (odds ratio [OR], 1.72; 95% CI, 1.11-2.67), moderate AD (OR, 2.09; 95% CI, 1.32-3.30), and severe to very severe AD (OR, 3.10; 95% CI, 1.55-6.19) on the POEM were all significantly more likely to have reported an LD than those with clear or almost clear skin. CONCLUSIONS AND RELEVANCE: This cross-sectional study found that worse AD severity was associated with greater odds of reported LD, independent of socioeconomic characteristics, AD onset age, and other related disorders. Although additional prospective and mechanistic studies are needed to clarify the association of AD with learning, the findings suggest that children with more severe AD should be screened for learning difficulties to initiate appropriate interventions that can mitigate the consequences of an LD.
IMPORTANCE: Recent population-based data indicate that atopic dermatitis (AD) is associated with learning disability (LD) in children, but the association between AD severity and LD is unknown. OBJECTIVE: To evaluate the association of AD severity with learning problems in children with AD. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study analyzed data of US participants enrolled in the Pediatric Eczema Elective Registry (PEER) between November 1, 2004, and November 30, 2019. Participants were children aged 2 to 17 years at registry enrollment with physician-confirmed diagnosis of AD and had completed 10 years of follow-up in PEER. EXPOSURES: Atopic dermatitis severity measured by both the Patient-Oriented Eczema Measure (POEM) score and self-report. The POEM scores ranged from 0 to 28, with strata of clear or almost clear skin (0-2), mild (3-7), moderate (8-16), severe (17-24), and very severe (25-28). Self-reported AD severity was categorized as clear skin or no symptoms, mild, moderate, or severe. MAIN OUTCOMES AND MEASURES: Learning disability diagnosed by a health care practitioner, as reported by the participants or their caregivers. RESULTS: Among the 2074 participants with AD (1116 girls [53.8%]; median [interquartile range (IQR)] age, 16.1 [13.9-19.5] years at 10-year follow-up), 169 (8.2%) reported a diagnosis of an LD. Children with an LD vs those without an LD were more likely to have worse AD severity, as measured by the median (IQR) total POEM score (5 [1-10] vs 2 [0-6]; P < .001), POEM severity category (moderate AD: 50 of 168 [29.8%] vs 321 of 1891 [17.0%]; severe to very severe AD: 15 of 168 [8.9%] vs 85 of 1891 [4.5%]; P < .001); and self-report (moderate AD: 49 of 168 [29.2%] vs 391 of 1891 [20.7%]; severe AD: 11 of 168 [6.5%] vs 64 of 1891 [3.4%]; P < .001). In multivariable logistic regression models adjusted for sex, age, race/ethnicity, annual household income, age of AD onset, family history of AD, and comorbid conditions, participants with mild AD (odds ratio [OR], 1.72; 95% CI, 1.11-2.67), moderate AD (OR, 2.09; 95% CI, 1.32-3.30), and severe to very severe AD (OR, 3.10; 95% CI, 1.55-6.19) on the POEM were all significantly more likely to have reported an LD than those with clear or almost clear skin. CONCLUSIONS AND RELEVANCE: This cross-sectional study found that worse AD severity was associated with greater odds of reported LD, independent of socioeconomic characteristics, AD onset age, and other related disorders. Although additional prospective and mechanistic studies are needed to clarify the association of AD with learning, the findings suggest that children with more severe AD should be screened for learning difficulties to initiate appropriate interventions that can mitigate the consequences of an LD.
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