Whiteley Jennifer, Emir Birol, Seitzman Robin, Makinson Geoffrey
a Pfizer Inc. , New York , NY , USA.
Curr Med Res Opin. 2016 Oct;32(10):1645-1651. doi: 10.1080/03007995.2016.1195733. Epub 2016 Jun 21.
To characterize comorbidities, health-related quality-of-life (HRQoL), productivity, and healthcare resource use in adults with atopic dermatitis (AD) relative to those without AD, and to evaluate the impact of patient-reported AD severity on these outcomes.
Data were from the 2013 National Health and Wellness Survey (NHWS), which collected self-reported information on demographics, comorbidities, HRQoL (SF-36v2 Health Survey), productivity (Work Productivity and Impairment questionnaire [WPAI]), and healthcare utilization, which were weighted to the US general population. The AD cohort consisted of subjects who reported that they experienced AD within the past 12 months (n = 428), and the non-AD cohort included all subjects who did not report experiencing AD (n = 74,572); 366 AD subjects self-reported mild (n = 182) or moderate/severe (n = 184) disease. Univariable and multivariable analyses compared characteristics and outcomes between cohorts and between AD severity levels.
The AD cohort was younger than non-AD cohort (44.3 vs. 46.6 years; P = 0.0033), and had a higher proportion of females (64.4% vs. 51.8%; P < 0.0001). Relative to the non-AD cohort, the AD cohort had a significantly higher prevalence of atopic conditions including nasal allergies (46.4% vs. 19.8%) and asthma (22.4% vs. 7.9%), and neuropsychiatric conditions such as anxiety (42.5% vs. 21.3%) and depression (37.2% vs. 20.9%) (all P < 0.0001). Units of resource use (healthcare practitioner visits, emergency room, hospitalizations) were higher (all P < 0.05) and HRQoL was poorer (P < 0.0001) with AD. On the WPAI, AD employees reported almost twice as much lost work productivity as non-AD employees (30.0% vs. 16.3%; P < 0.0001). No clear differences in outcomes were observed among patient-reported AD severity categories, except greater impairment of work productivity and daily activities in those with moderate/severe AD relative to mild.
The significant burden associated with AD relative to those without AD suggests an unmet need for more effective management strategies. There also appears to be a need for further characterization of disease severity and its impact on HRQoL.
描述特应性皮炎（AD）成人患者相对于非AD患者的合并症、健康相关生活质量（HRQoL）、生产力及医疗资源利用情况，并评估患者报告的AD严重程度对这些结果的影响。
数据来自2013年全国健康与健康调查（NHWS），该调查收集了关于人口统计学、合并症、HRQoL（SF - 36v2健康调查）、生产力（工作生产力与损伤问卷[WPAI]）及医疗利用的自我报告信息，并根据美国普通人群进行加权。AD队列由报告在过去12个月内经历过AD的受试者组成（n = 428），非AD队列包括所有未报告经历过AD的受试者（n = 74,572）；366名AD受试者自我报告为轻度（n = 182）或中度/重度（n = 184）疾病。单变量和多变量分析比较了队列之间以及AD严重程度水平之间的特征和结果。
AD队列比非AD队列年轻（44.3岁对46.6岁；P = 0.0033），女性比例更高（64.4%对51.8%；P < 0.0001）。相对于非AD队列，AD队列中特应性疾病的患病率显著更高，包括鼻过敏（46.4%对19.8%）和哮喘（22.4%对7.9%），以及神经精神疾病如焦虑（42.5%对21.3%）和抑郁（37.2%对20.9%）（所有P < 0.0001）。AD患者的资源利用单位（看医疗保健从业者、急诊室就诊、住院）更高（所有P < 0.05），HRQoL更差（P < 0.0001）。在WPAI上，AD员工报告的工作生产力损失几乎是非AD员工的两倍（30.0%对16.3%；P < 0.0001）。除了中度/重度AD患者相对于轻度患者在工作生产力和日常活动方面的损害更大外，在患者报告的AD严重程度类别之间未观察到结果有明显差异。
与非AD患者相比，AD患者的显著负担表明对更有效管理策略的需求未得到满足。似乎还需要进一步描述疾病严重程度及其对HRQoL的影响。
