Association Between Atopic Dermatitis and Impaired Mobility among Adults in the United States: Findings from the 2001-2006 National Health and Nutrition Examination Survey

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by Sara Osborne, BS; Olivia Kam, BA; Carolynne Vo, BS; Raquel Wescott, BS; Shivani Thacker, DO; and Jashin J. Wu, MD

Ms. Osborne is with the University of Minnesota Medical School in Minneapolis, Minnesota. Ms. Kam is with the Stony Brook School of Medicine in New York, New York. Ms. Vo is with the University of California Riverside School of Medicine in Riverside, California. Ms. Wescott is with the University of Nevada Reno School of Medicine in Reno, Nevada. Dr. Thacker is with KPC Hemet Medical Center in Santa Ana, California. Dr. Wu is with the University of Miami Miller School of Medicine in Miami, Florida.

FUNDING: No funding was provided for this article.

DISCLOSURES: Dr. Wu is or has been an investigator, consultant, or speaker for AbbVie, Almirall, Amgen, Arcutis, Aristea Therapeutics, Bausch Health, Boehringer Ingelheim, Bristol-Myers Squibb, Dermavant, DermTech, Dr. Reddy’s Laboratories, Eli Lilly, EPI Health, Galderma, Janssen, LEO Pharma, Mindera, Novartis, Pfizer, Regeneron, Samsung Bioepis, Sanofi Genzyme, Solius, Sun Pharmaceutical, UCB, and Zerigo Health. The remaining authors have no conflicts of interest to disclose.

ABSTRACT: Objective. Atopic dermatitis (AD) is an inflammatory skin condition affecting both mental and physical health. Although research has shown reduced physical activity levels among patients with AD, there is a scarcity of studies examining baseline mobility, which refers to the standard level of functional ambulation or movement capability. We analyzed the relationship between AD and baseline mobility among U.S. adults ages 20 to 59, utilizing the National Health and Nutrition Examination Survey (NHANES).

Methods. We merged three, 2-year cycles of NHANEs data (2001-2006). Patients were categorized as having “impaired mobility” by the following question: “Because of a health problem, do you have difficulty walking without using any special equipment?” Multivariable logistic regression analyses were performed using STATA/SE 18.0.

Results. Our analysis included 6,540 participants. The prevalence of impaired mobility was 7.1 percent among patients with AD and 3.9 percent among those without AD. This difference was statistically significant among patients aged 20 to 59 after adjusting for potential confounding variables (adjusted odds ratio [AOR], 1.65; 95% CI, 1.19-3.25; P=0.010). Subgroup analysis showed increased rates of impaired mobility among males with AD (AOR, 2.55; 95% CI, 1.21-5.40; P=0.016), and among adults aged 40 to 59 (AOR, 1.94; 95% CI, 1.03-3.68; P=0.042).

Limitations. Limitations to our study include lack of specificity in the survey questionnaire, self-reporting bias, and an age limit of 59 years old.

Conclusion. Our study demonstrated a statistically significant elevation in impaired mobility among individuals with AD compared to those without AD. This underscores the importance of comprehensive care for AD patients.

Keywords: Atopic dermatitis, mobility, movement, impairment, impaired, adults, National Health and Nutrition Examination Survey


Introduction

Atopic dermatitis (AD) is a chronic inflammatory skin condition with far-reaching consequences for an affected individual’s quality of life. Beyond the immediate symptoms of pruritis and rash, AD significantly impacts psychological and physical well-being, often leading to a cascade of detrimental effects on daily living activities.1 Studies have consistently reported that individuals with AD experience higher rates of sleep disturbances due to pruritus, which can lead to daytime fatigue and cognitive impairment.2 The persistent discomfort associated with AD can also exacerbate stress and anxiety, contributing to a vicious cycle that can further aggravate skin symptoms.3 Physically, the disease’s visibility can lead to stigmatization and social withdrawal, impacting social interactions and the ability to maintain relationships.4 The chronic nature of the disease often requires ongoing treatment and skin care routines, which can be time-consuming and burdensome, limiting participation in activities and reducing overall life satisfaction.5

In addition to the myriad of psychological implications of AD, physical capabilities, such as exercise intensity, have also been shown to be diminished among those with atopic dermatitis. A study by Hsieh et al. in 2022 demonstrated decreased exercise intensity among Taiwanese populations with advanced AD.6 This is comparable to research in U.S. cohorts, which have also indicated an overall decrease in exercise intensity among individuals with AD.7.8 Other metrics of physical capability, such as baseline mobility, has been a relatively underexplored area of AD’s burden. Baseline mobility is defined as the standard level of functional ambulation or movement capability. This study aims to bridge this knowledge gap by analyzing the relationship between AD and mobility in U.S. adults aged 20 to 59, utilizing data from the National Health and Nutrition Examination Survey (NHANES) collected between 2001 and 2006.9

In this cross-sectional study, we synthesized data across three consecutive 2-year cycles of the NHANES database spanning from 2001 to 2006. This merging of datasets allowed us to construct a robust sample size, enhancing the reliability of findings. To assess baseline mobility within this population, we operationalized mobility metrics through self-reported walking difficulties. Patients in the survey were asked to reflect on their physical capabilities and were categorized as having impaired mobility if they responded affirmatively to the question: “Because of a health problem, do you have difficulty walking without using any special equipment?” In analyzing the relationship between AD and impaired mobility, we applied multivariable logistic regression analyses, utilizing STATA/SE 18.0. Age, income, education, sex, race, tobacco use, diabetes, and body mass index (BMI) were controlled for in our models. As previous research has revealed an association between arthritis and AD, we controlled for arthritis to reduce potential confounding effects.10

Our analysis initially comprised 10,088 individuals. There were 3,548 subjects who did not respond to questions assessing AD and impaired mobility; these individuals were excluded. The prevalence of impaired mobility was 7.1 percent weighted among patients with AD and 3.9 percent weighted among those without AD (Table 1). There was a significant association between AD and impaired mobility among patients aged 20 to 59 after adjusting for potential confounding variables (adjusted odds ratio [AOR], 1.65; 95% CI, 1.19-3.25; P=0.010) (Table 2). An analysis of subgroups showed significantly increased odds of impaired mobility among male patients with AD (AOR, 2.55; 95% CI, 1.21-5.40; P=0.016), and among adults aged 40-59 (AOR, 1.94; 95% CI, 1.03-3.68; P=0.042) (Table 2). Further analyses of subgroups yielded no statistically significant results.

Our study demonstrated a statistically significant increase in impaired mobility in individuals with AD compared to those without AD, which remained significant in subgroup analysis of men and individuals aged 40 to 59. Older adults with AD may experience increased rates of impaired mobility due to age-related changes in skin barrier function and immune response, both of which deteriorate naturally with age and are further impacted by AD-related pathophysiological changes.11 The decline in skin barrier function can lead to increased dryness and pruritus, limiting daily activities and mobility.11 Additionally, the immune response in AD skews towards a type-2 T helper cell profile, which sustains the inflammatory process. This systemic inflammation can potentially extend to affect musculoskeletal health, thereby impacting physical function and mobility.12 New medications to treat AD such as dupilumab, have side effects of muscle weakness and joint pain.13,14 These medications were not available at the time of the survey; thus, they did not contribute to impaired mobility in this study. Despite this, investigating the association between dupilumab use and impaired mobility in adults may be an area of future research.

Our study underscores the critical need for inclusive care approaches for AD patients, as they are more likely to face mobility impairments compared to the general population. The introduction of our study outlines the substantial burden that AD can impose on an individual’s daily function. Research in populations without AD indicates that impaired mobility is associated with decreased quality of life due to the functional limitations it imposes.15 There is a need for additional research to determine whether similar correlations exist for AD patients with mobility impairments. 

Limitations to our study include the lack of specificity in the survey questionnaire, as the type of equipment used for aiding in mobility remained unspecified. There is also the potential for self-reporting bias due to the nature of the survey being directed towards participants and not their healthcare providers. We were limited to age 59 years old as this was the oldest age recorded for atopic dermatitis in the NHANEs database during the specified timeframe. Further investigations are warranted in large, representative U.S. adult populations to assess the causality between impaired mobility and AD.

References

  1. Gochnauer H, Valdes-Rodriguez R, Cardwell L, et al. The Psychosocial Impact of Atopic Dermatitis. Adv Exp Med Biol. 2017;1027:57–69. 
  2. Angelhoff C, Askenteg H, Wikner U, et al. “To Cope with Everyday Life, I Need to Sleep” – A Phenomenographic Study Exploring Sleep Loss in Parents of Children with Atopic Dermatitis. J Pediatr Nurs. 2018 Nov-Dec;43:e59–e65. 
  3. Lönndahl L, Abdelhadi S, Holst M, et al. Psychological Stress and Atopic Dermatitis: A Focus Group Study. Ann Dermatol. 2023 Oct;35(5):342–347. 
  4. Senra MS, Wollenberg A. Psychodermatological aspects of atopic dermatitis. Br J Dermatol. 
  5. Chovatiya R, Silverberg JI. Iatrogenic Burden of Atopic Dermatitis. Dermatitis. 2022 Nov-Dec 01;33(6S):S17–S23. 
  6. Hsieh BJ, Shen D, Hsu CJ, et al. The impact of atopic dermatitis on health-related quality of life in Taiwan. J Formos Med Assoc. 2022 Jan;121(1 Pt 2):269–277.
  7. Silverberg JI, Song J, Pinto D, et al. Atopic Dermatitis Is Associated with Less Physical Activity in US Adults. J Invest Dermatol. 2016 Aug;136(8):1714–1716. 
  8. Schwartzman G, Lei D, Ahmed A, et al. Association of Adult Atopic Dermatitis Severity With Decreased Physical Activity: A Cross-sectional Study. Dermatitis. 2023 May-Jun;34(3):218–223. 
  9. Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey Data. Web site.https://wwwn.cdc.gov/nchs/nhanes/Default.aspx. Accessed October 29, 2023
  10. Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey Data. Web site.https://wwwn.cdc.gov/nchs/nhanes/Default.aspx. Accessed October 29, 2023
  11. Smith B, Engel P, Collier MR, et al. Association between atopic dermatitis/eczema and arthritis among US adults. J Eur Acad Dermatol Venereol. 2023 Jul;37(7):e855–e857.
  12. Williamson S, Merritt J, De Benedetto A. Atopic dermatitis in the elderly: a review of clinical and pathophysiological hallmarks. Br J Dermatol. 2020 Jan;182(1):47–54. 
  13. Fasseeh AN, Elezbawy B, Korra N, et al. Burden of Atopic Dermatitis in Adults and Adolescents: a Systematic Literature Review. Dermatol Ther (Heidelb). 2022 Dec;12(12):2653–2668. 
  14. Tanei R. Atopic Dermatitis in Older Adults: A Review of Treatment Options. Drugs Aging. 2020 Mar;37(3):149–160. 
  15. Boesjes CM, van Emst M, Bakker DS, et al. Muscle and joint pain during dupilumab treatment for atopic dermatitis: Lack of association with antinuclear antibodies. Clin Exp Allergy. 2023 May;53(5):582–585. 
  16. Lindgren Westlund K, Jong M. Quality of Life of People with Mobility-Related Disabilities in Sweden: A Comparative Cross-Sectional Study. Int J Environ Res Public Health. 2022 Nov 16;19(22):15109.  

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Recent Articles:

Letters to the Editor: June 2024
A Seven-week, Open-label Trial Evaluating the Safety and Efficacy of a Photopneumatic Device for Mitigating Mild-to-Moderate Acne in Healthy Adolescents and Young Adults
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A Retrospective Review of a Cohort of Patients with Periorificial Dermatitis Treated with Sarecycline
Comparison of Patch Testing Results of White and Black Patients
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Mantle Cell Lymphoma and Exaggerated Mosquito Bite Reactions: A New Perspective on Treatment Options
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