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The prevalence of atopic dermatitis in Oregon schoolchildren☆,☆☆,★

https://doi.org/10.1067/mjd.2000.107773Get rights and content

Abstract

Background: Although surveys from many parts of the world have shown that the prevalence of atopic dermatitis (AD) in schoolchildren has increased greatly in the past 40 years, there is no current prevalence information from the United States. Objective: Our objective was to investigate the utility of a recently developed European questionnaire to estimate the prevalence of AD in urban and rural Oregon schoolchildren. Methods: The self-administered Schultz-Larsen questionnaire (SLQ) of AD symptoms and history was completed by the parents of a broad socioeconomic and ethnic mix of 5- to 9-year-old schoolchildren from 6 urban and 2 rural elementary schools in Oregon. Validation assessments included comparisons of the questionnaire scores with clinical examination in a group of age-matched children and with specific history components known to correlate with AD. Results: Data showed a prevalence of 17.2% using standard scoring criteria for the SLQ and with a lower limit of 6.8% according to highly stringent criteria derived from the validation study using dermatologic examination. A single question (“Has a doctor ever said that your child has eczema?”) was highly concordant with the questionnaire determination, yielding very high predictive accuracy (91.2%). Conclusion: This study of childhood AD frequency indicates a high prevalence of AD in the United States, comparable to that recently observed from studies in Europe and Japan. (J Am Acad Dermatol 2000;43:649-55.).

Section snippets

Selection of school population

The survey was conducted in 8 public elementary schools in Oregon: 6 urban schools in the Portland metropolitan area and 2 rural schools (one in the central Oregon town of Sisters, and one in the coastal town of Seaside). Using the data reported by Schultz-Larsen, Diepgen, and Svensson19 as an estimate of AD in Oregon, we determined that a sample size of 1225 or more would provide a relatively high degree of statistical precision in our survey.

To help us examine differences in AD prevalence by

Demographics of school respondents

A total of 1465 survey questionnaires were returned. A total of 730 boys and 724 girls participated in the study (11 respondents failed to regard gender). Response rates ranged from 32% to 88%, with an overall response rate of 56.8%. The highest rate was from the rural high-desert school, whereas lower return rates in urban schools showed a rough correlation with socioeconomic levels. The indicator used by the school districts for determining socioeconomic status of the school population is the

Discussion

In this large sample of American schoolchildren, using the Schultz-Larsen study cut-off of 50+ points, we found a history of AD reported for 17.2% of Oregon schoolchildren, a figure that compares fairly closely with the 15.6% prevalence figure derived from northern European countries.19 As another comparison, a recent study of 5- to 9-year-old Japanese schoolchildren that employed direct clinical examination reported that there was evidence of AD in 21% of this age group.22

Measurement of the

Acknowledgements

We appreciate the helpful comments of Robert O. McAlister, PhD, William Keene, PhD, and Michael Heumann, MS. We thank Alfredo P. Sandoval for assisting with data analysis and Christine McClure for the excellent manuscript preparation.

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Supported by a generous grant from Procter & Gamble through the National Eczema Association for Science and Education.

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Reprint requests: Jon M. Hanifin, MD, Oregon Health Sciences University, Department of Dermatology L468, 3181 SW Sam Jackson Park Rd, Portland, OR 97201-3098. E-mail: [email protected].

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J Am Acad Dermatol 2000;43:649-55.

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Copyright © 2000 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.