Childhood AD Affects Educational Outcomes, New Analysis Finds

Children who grow up with atopic dermatitis (AD) are less likely than their peers to complete formal education at all levels, according to a new analysis.

The report, published in the Journal of the European Academy of Dermatology and Venereology, highlights AD’s far-reaching implications in the lives of people who suffer from the condition.

AD is relatively common in young children, wrote corresponding author Kristofer Pálsson, of the University of Copenhagen in Denmark. About 13% of Danish children under the age of 5 are diagnosed with the condition, though in many cases the symptoms of AD diminish as the child ages.

Still, AD has been linked to a number of comorbidities, such as psychiatric and cardiovascular conditions, and in adults it is associated with increased absenteeism and job instability. What has not been clear, however, is the disease’s impact on education in children.

The investigators decided to look at the issue by probing a Danish national database to compare the educational outcomes of children with AD to those of a matched control group. The 5 databases used in the study included a register of educational outcomes, as well as databases on health care records and socioeconomic data.

They compiled a study population of 10,173 children born between the years 1977 and 1993 who were diagnosed with AD by the age of 16, as well as 234,683 healthy matched controls.

The results showed patients with an AD diagnosis had markedly different educational outcomes.

“Our register-based cohort study of all Danish childhood-diagnosed AD patients, registered at hospitals, confirmed our hypotheses that AD patients have a decreased chance of completing their education later in life or only doing so at an older age,” Pálsson and colleagues wrote.

Children with mild or moderate AD had a lower chance of completing basic compulsory education (Hazard Ratio [HR] 0.92; 95% CI, 0.90-0.95) and of completing academic education beyond the compulsory minimum (HR 0.96; 95% CI, 0.93-0.98). Among children with severe AD, the rates of completing education beyond basic compulsory education were even lower (HR 0.86; 95% CI, 0.80-0.92), as were the odds of completing vocational education (HR 0.90; 95% CI, 0.84-0.97) and master’s level education (HR 0.66; 95% CI, 0.53-0.81).

Even when patients with severe AD completed their education, they tended to do so at an older age than their peers in the control group, suggesting the disease slowed down their academic progress, potentially due to absenteeism or other related issues. Among children with mild or moderate AD, those who completed their education did so at a slightly younger age than the control group. The authors hypothesized multiple potential reasons for this, though they also said it may be due to the fact that ages were matched between the 2 groups based on birth year, rather than birth month.

Pálsson and colleagues said their findings could be used by physicians and parents to better understand the challenges faced by children with AD.

“If practitioners become aware of the reduced educational attainment of AD patients, they could prepare and counsel parents appropriately and education interventions could be made to aid the patients and their parents,” they wrote.

The investigators added that the data in this study might also be helpful to examine the cost-effectiveness of more aggressive treatments of AD, given that the study makes clear the societal impacts of the disease. However, the authors also noted that treatment of AD has already improved over time. They said more effective treatments likely have already closed some of the educational gaps among children born in the latter part of the study and those born after the time frame included.

Reference:

Pálsson K, Slagor RM, Flachs EM, Nørreslet LB, Agner T, and Ebbehøj NE. Childhood atopic dermatitis is associated with a decreased chance of completing education later in life: a register-based cohort study. J Eur Acad Dermatol Venereol. Published online May 14, 2021. doi:10.1111/jdv.17346