Childhood AD Shows Small Impact on Educational Attainment

A childhood diagnosis of atopic dermatitis was associated with lower attainment of secondary education but not higher education, according to a population-based study.

“Atopic dermatitis (AD) may affect academic performance through multiple pathways, including poor concentration associated with itching, sleep deprivation or adverse effects of medications,” Sigrun Alba Johannesdottir Schmidt, PhD, of the department of clinical epidemiology and the department of dermatology at Aarhus University Hospital, Denmark, and colleagues wrote. “Because educational attainment is associated with health and well-being, any association with a prevalent condition such as AD is of major importance.”

In the cohort study that included data from Jan. 1, 1977, through June 30, 2017, the researchers aimed to assess whether childhood AD was associated with lower educational attainment.

Eligible participants had been born in Denmark on or before June 30, 1987, and had been diagnosed with AD before their 13th birthday. The findings in the AD group were compared with those observed in an age- and sex-matched comparison cohort. There was also a secondary analysis conducted in exposure-discordant siblings of children with AD.

Of the 61,153 children included, 5,927 had AD and 55,226 were from the general population. Both cohorts were approximately 56% male.

Results showed that children with AD were at an increased risk of failing to attain lower secondary education levels compared with the general population, 2.5% vs. 1.7% (RR = 1.50; 95% CI, 1.26-1.78). Similarly, children in the AD cohort were also more likely than healthy controls to fail to reach upper secondary education, 19.8% vs. 16.4% (RR = 1.16; 95% CI, 1.09-1.24).

However, higher education rates were 51.9% for the AD group and 53.1% for the non-AD group (RR = 0.95; 95% CI, 0.91-1.00), according to the findings.

The researchers noted that the absolute differences in probability of attaining education levels were less than 3.5%.

Looking at the comparison between 3,259 children in the AD group and 4,046 of their full siblings, the researchers reported that the differences were “less pronounced” than those observed in the main analysis.

Children with AD were more likely to fail to obtain lower secondary education than their siblings (RR = 1.29; 95% CI, 0.92-1.82). Similar outcomes as seen in the primary analysis were reported for upper secondary education (RR = 1.05; 95% CI, 0.93-1.18) and higher education (RR = 0.94; 95% CI, 0.87-1.02).

“This population-based cohort study found that hospital-diagnosed AD was associated with reduced educational attainment, but the clinical importance was uncertain owing to small absolute differences and possible confounding by familial factors in this study,” the researchers wrote. “Future studies should examine for replicability in other populations and variation by AD phenotype.”