Journal Reading

Risks for comorbidity in children with atopic

disorders: an observational study in Dutch
general practices
Perceptor: dr. Arif Effendi, Sp. KK
 Anita Rahayu  Mulya Dita Paramita
 Aulian Mediansyah  Natasyah Hana Z
 Fadel M. Ikrom  Tara Aulianova
 Mentari Olivia F  Tesia Iryani
 Meti Destriyana  Wage Nurmaulina

SMF ILMU KULIT DAN KELAMIN

RUMAH SAKIT UMUM DAERAH DR. H. ABDUL MOELOEK
BANDAR LAMPUNG
2018
 Critical Appraisal

VIA PICO
Validity, Importancy, Applicability Patients, People, or Problem
Intervention
Comparison
Outcome
 Validity VIA
Title : Clear, informative, no abreviation

Correspondency: Clear, complete,

without mentioning the title, the lead
author in the order ahead. Author
details, institution and correspondency
email is also clear
 Abstract VIA

Abstract : well-stuctured
 Introduction VIA
Atopic disorders represent an important health problem in general practice. Acute upper airway
infections, middle ear infections, warts, asthma and atopic eczema represent the five most prevalent
paediatric diseases diagnosed in general practice. Associations have been shown between atopic
disorders and other diseases in children.

No study has investigated the complete range of potential

comorbidities in children with atopic disorders in a general practice
setting.

For the present study, only morbidity data from EHRs of general practices with sufficient
data quality were used that fulfilled the following criteria: (1) at least 500 listed patients
(standard practice: 2350 patients), (2) complete morbidity registration (defined as
≥46weeks/ year) and (3) sufficient ICPC coding of diagnostic information (defined as ≥70%
of the recorded disease episodes labelled with an ICPC code; the average ICPC coding in a
Dutch general practice is >95%).
This journal was published on BMJ Open 2017;7
 Methods
Study Population

• Electronic Health Records (EHRs) of all listed patients in

participating practices from The Netherlands Institute for Health
Services Research-Primary Care Database (NIVEL-PCD), including
data of 1.700.000 patients

ICPC and episodes of care

• Morbidity data frome EHRs of GP with sufficient data quality were

used that fulfilled the following criteria:
• 1. at least 500 listed patients
• 2. Complete morbidity registration (>= 46 weeks/year)
• 3. ICPC coding of diagnostic information
 Methods

Children with atopic disorder

• For each child (0-18 years), a minimum follow-up for 3 years was
required
• The atopic diagnosis was based on the physician’s assessment and
was considered to be a chronic problem

Symptoms and diseases studied

• After establishing which child had an atopic disorder, a child was

considered prevalent for a specific symptom or disease if the child
had at least one active episode of care for that symptom or
disorder between January and December of 2014.
• 404 different ICPC codes were examined
 Methods

Design

• An observational study design was used in which cases with one

atopic disorder were matched with controls without any atopic
disorder.
• Controls were only matched if a 100% match on age, gender and
general practice with a child with atopic disorders was
determined.

Statistical analyses

• Logistic regression analyses was performed to study associations

between the presence of atopic disorders and non-atopic
comorbid symptoms and diseases in children.
 Result
There were 409.312 children identified in 2014, including 70.494 children with at least
one atopic disorder. There were 559 children had all three atopic disorder.
Result
Result
 Result

Having all three atopic disorders is relatively rare, with only a few symptoms and diseases
being significantly related. The risk for developing an ‘alllergy’ that the GP considered high
(OR: 17.8). Allergic conjunctivitis (OR: 6.8) is also frequently seen in children with all three
atopic disorders.
 Discusion
The large number of children gives the study substantial power and generalizability. This
study showed that children with atopiv disorders have an increased risk for the
development of both atopic and non-atopic diseases and symptoms.

Children with atopic eczema had an increased risk of developing infectious skin diseases
such as warts, impetigo, dermatophytosis and molluscum contagiosum. Children with
asthma seem to have been presented for airway-related infections such as acute
laryngitis/tracheitis, acute upper respiratory infection, pneumonia and bronchitis. Childrren
with allergic rhinitis were presented more frequently for ear-nose-throat related
symptoms and diseases. Gastrointestinal-related symptoms are also frequently diagnoses
in children with atopic disorders.
 Discusion

Limitations
1. The GP’s choice for ICPC coding of an episode of care
2. The unavoidable multiple testing
3. There is no explanation on socioeconomic status, tobacco smoke
exposure and other lifestyle-related risk factors, because they are
not recorded in NIVEL-PCD.
4. Children with atopic disorder might be presented more frequently
than non-atopic children.
5. The diagnoses are based on a physician’s assessment and not on
confirmed sensitization pattern for allergens.
 Conclusions

The present study shows that children with atopic disorders have an
increased risk of clinically relevant comorbidity, both atopic and non-
atopic
 Importancy VIA

With this study, it is possible to know if comorbidity data could be

used to create proxies that could support GPs in identifying children
wiht atopic disorders that are not labelled. However, future
researches are required.
 Critical Appraisal PICO
• 409. 312 children, 70.494 children at least one atopic disorder (15.350
children with atopic eczema, 7887 with asthma, and 6.835 children with
Population allergic rhinitis, 559 children with three atopic disorder)

• Observational study design was used in which cases with one atopic
disorder were matched with controls without any atopic disorder.
Intervention

• Non-atopic children / controls (31.060 children)

Comparison

• Children with atopic disorder have an increased risk of clinically

relevant comorbidity, both atopic and non-atopic.
Outcome
 Applicability

The result of this reseach can be a reference that will help physician
or dermatologist diagnose an atopic disease with comorbid
symptoms. However, using general pratcise databases also has it
limitations.
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