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1. Estimating geographic variation of infection fatality ratios during epidemics.

Author

Bansal, Ishan, Hoffman, Elijah, Joachimiak, Marcin, Mora, Ana, Walker, Angelica, Wu, Yulun, Pavicic, Mirko, Jacobson, Daniel, Ladau, Joshua, Hess, Matthias, Brodie, Eoin, Brown, James, Wainwright, Haruko, Falco, Nicola, and Abuabara, Katrina

Subjects
COVID-19, Infection fatality rate, Infection fatality ratio, Noncentral hypergeometric distribution, SARS-CoV-2
Abstract

OBJECTIVES: We aim to estimate geographic variability in total numbers of infections and infection fatality ratios (IFR; the number of deaths caused by an infection per 1,000 infected people) when the availability and quality of data on disease burden are limited during an epidemic. METHODS: We develop a noncentral hypergeometric framework that accounts for differential probabilities of positive tests and reflects the fact that symptomatic people are more likely to seek testing. We demonstrate the robustness, accuracy, and precision of this framework, and apply it to the United States (U.S.) COVID-19 pandemic to estimate county-level SARS-CoV-2 IFRs. RESULTS: The estimators for the numbers of infections and IFRs showed high accuracy and precision; for instance, when applied to simulated validation data sets, across counties, Pearson correlation coefficients between estimator means and true values were 0.996 and 0.928, respectively, and they showed strong robustness to model misspecification. Applying the county-level estimators to the real, unsimulated COVID-19 data spanning April 1, 2020 to September 30, 2020 from across the U.S., we found that IFRs varied from 0 to 44.69, with a standard deviation of 3.55 and a median of 2.14. CONCLUSIONS: The proposed estimation framework can be used to identify geographic variation in IFRs across settings.

Published
2024

3. The association between atopic eczema and lymphopenia: Results from a UK cohort study with replication in US survey data.

Author

Hollestein, Loes, Ye, Morgan, Ang, Ky-Leigh, Forbes, Harriet, Mansfield, Kathryn, Smeeth, Liam, Langan, Sinéad, and Abuabara, Katrina

Subjects
Adult, Male, Humans, Dermatitis, Atopic, Cohort Studies, Nutrition Surveys, Eczema, Lymphopenia, United Kingdom
Abstract

BACKGROUND: Lymphocyte skin homing in atopic eczema (AE) may induce lymphopenia. OBJECTIVE: To determine if AE is associated with lymphopenia. METHODS: We used UK primary care electronic health records (Clinical Practice Research Datalink GOLD) for a matched cohort study in adults (18 years+) (1997-2015) with at least one recorded lymphocyte count. We matched people with AE to up to five people without. We used multivariable logistic regression to estimate the association between AE and lymphopenia (two low lymphocyte counts within 3 months) and linear mixed effects regression to estimate the association with absolute lymphocyte counts using all available counts. Cox proportional hazard models were used to investigate the effect of lymphopenia on common infections. We replicated the study using US survey data (National Health and Nutrition Examination Survey [NHANES]). RESULTS: Among 71,731 adults with AE and 126,349 adults without AE, we found an adjusted odds ratio (OR) for lymphopenia of 1.16 (95% CI: 1.09-1.23); the strength of association increased with increasing eczema severity. When comparing all recorded lymphocyte counts from adults with AE (n = 1,497,306) to those of people without AE (n = 4,035,870) we saw a lower mean lymphocyte (adjusted mean difference -0.047 × 109 /L [95% CI: -0.051 to -0.043]) in those with AE. The difference was larger for men, with increasing age, and with increasing AE severity and was present among people with AE not treated with immunosuppressive drugs. In NHANES (n = 22,624), the adjusted OR for lymphopenia in adults with AE was 1.30 (95% CI: 0.80-2.11), and the adjusted mean lymphocyte count difference was -0.03 × 109 /L (95% CI: -0.07 to 0.02). Despite having a lower lymphocyte count, adjusting for time with lymphopenia, did not alter risk estimates of infections. CONCLUSION: Atopic eczema, including increasing AE severity, is associated with a decreased lymphocyte count, regardless of immunosuppressive drug use. Whether the lower lymphocyte count has wider health implications for people with severe eczema warrants further investigation.

Published
2023

4. Efficacy and Safety of Dupilumab Maintained in Adults ≥ 60 Years of Age with Moderate-to-Severe Atopic Dermatitis: Analysis of Pooled Data from Four Randomized Clinical Trials

Author

Silverberg, Jonathan I, Lynde, Charles W, Abuabara, Katrina, Patruno, Cataldo, de Benedetto, Anna, Zhang, Haixin, Thomas, Ryan B, Bégo-Le-Bagousse, Gaëlle, Khokhar, Faisal A, Vakil, Jignesh, Marco, Ainara Rodríguez, and Levit, Noah A

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Clinical Trials and Supportive Activities, Clinical Research, Aging, Evaluation of treatments and therapeutic interventions, 6.1 Pharmaceuticals, Skin, Humans, Adult, Middle Aged, Aged, Dermatitis, Atopic, Quality of Life, Injections, Subcutaneous, Double-Blind Method, Severity of Illness Index, Randomized Controlled Trials as Topic, Treatment Outcome, Dermatology & Venereal Diseases, Clinical sciences
Abstract

BackgroundAdults aged ≥ 60 years are often underrepresented in atopic dermatitis (AD) clinical trials; age-related comorbidities may impact treatment efficacy and safety.ObjectiveThe aim was to report dupilumab efficacy and safety in patients aged ≥ 60 years with moderate-to-severe AD.MethodsData were pooled from four randomized, placebo-controlled dupilumab trials of patients with moderate-to-severe AD (LIBERTY AD SOLO 1 and 2, LIBERTY AD CAFÉ, and LIBERTY AD CHRONOS) and stratified by age (

Published
2023

5. Air Pollution and Atopic Dermatitis, from Molecular Mechanisms to Population-Level Evidence: A Review

Author

Fadadu, Raj P, Abuabara, Katrina, Balmes, John R, Hanifin, Jon M, and Wei, Maria L

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Health Sciences, Climate-Related Exposures and Conditions, Prevention, Clinical Research, Eczema / Atopic Dermatitis, 2.1 Biological and endogenous factors, Aetiology, Skin, Animals, Dermatitis, Atopic, Cross-Sectional Studies, Air Pollution, Air Pollutants, Particulate Matter, Environmental Exposure, air pollutants, air pollution, atopic dermatitis, eczema, environment, particulate matter, pollution, review, wildfires, Toxicology
Abstract

Atopic dermatitis (AD) has increased in prevalence to become the most common inflammatory skin condition globally, and geographic variation and migration studies suggest an important role for environmental triggers. Air pollution, especially due to industrialization and wildfires, may contribute to the development and exacerbation of AD. We provide a comprehensive, multidisciplinary review of existing molecular and epidemiologic studies on the associations of air pollutants and AD symptoms, prevalence, incidence, severity, and clinic visits. Cell and animal studies demonstrated that air pollutants contribute to AD symptoms and disease by activating the aryl hydrocarbon receptor pathway, promoting oxidative stress, initiating a proinflammatory response, and disrupting the skin barrier function. Epidemiologic studies overall report that air pollution is associated with AD among both children and adults, though the results are not consistent among cross-sectional studies. Studies on healthcare use for AD found positive correlations between medical visits for AD and air pollutants. As the air quality worsens in many areas globally, it is important to recognize how this can increase the risk for AD, to be aware of the increased demand for AD-related medical care, and to understand how to counsel patients regarding their skin health. Further research is needed to develop treatments that prevent or mitigate air pollution-related AD symptoms.

Published
2023

7. European and multi-ancestry genome-wide association meta-analysis of atopic dermatitis highlights importance of systemic immune regulation

Author

Budu-Aggrey, Ashley, Kilanowski, Anna, Sobczyk, Maria K., Shringarpure, Suyash S., Mitchell, Ruth, Reis, Kadri, Reigo, Anu, Mägi, Reedik, Nelis, Mari, Tanaka, Nao, Brumpton, Ben M., Thomas, Laurent F., Sole-Navais, Pol, Flatley, Christopher, Espuela-Ortiz, Antonio, Herrera-Luis, Esther, Lominchar, Jesus V. T., Bork-Jensen, Jette, Marenholz, Ingo, Arnau-Soler, Aleix, Jeong, Ayoung, Fawcett, Katherine A., Baurecht, Hansjorg, Rodriguez, Elke, Alves, Alexessander Couto, Kumar, Ashish, Sleiman, Patrick M., Chang, Xiao, Medina-Gomez, Carolina, Hu, Chen, Xu, Cheng-jian, Qi, Cancan, El-Heis, Sarah, Titcombe, Philip, Antoun, Elie, Fadista, João, Wang, Carol A., Thiering, Elisabeth, Wu, Baojun, Kress, Sara, Kothalawala, Dilini M., Kadalayil, Latha, Duan, Jiasong, Zhang, Hongmei, Hadebe, Sabelo, Hoffmann, Thomas, Jorgenson, Eric, Choquet, Hélène, Risch, Neil, Njølstad, Pål, Andreassen, Ole A., Johansson, Stefan, Almqvist, Catarina, Gong, Tong, Ullemar, Vilhelmina, Karlsson, Robert, Magnusson, Patrik K. E., Szwajda, Agnieszka, Burchard, Esteban G., Thyssen, Jacob P., Hansen, Torben, Kårhus, Line L., Dantoft, Thomas M., Jeanrenaud, Alexander C.S.N., Ghauri, Ahla, Arnold, Andreas, Homuth, Georg, Lau, Susanne, Nöthen, Markus M., Hübner, Norbert, Imboden, Medea, Visconti, Alessia, Falchi, Mario, Bataille, Veronique, Hysi, Pirro, Ballardini, Natalia, Boomsma, Dorret I., Hottenga, Jouke J., Müller-Nurasyid, Martina, Ahluwalia, Tarunveer S., Stokholm, Jakob, Chawes, Bo, Schoos, Ann-Marie M., Esplugues, Ana, Bustamante, Mariona, Raby, Benjamin, Arshad, Syed, German, Chris, Esko, Tõnu, Milani, Lili A., Metspalu, Andres, Terao, Chikashi, Abuabara, Katrina, Løset, Mari, Hveem, Kristian, Jacobsson, Bo, Pino-Yanes, Maria, Strachan, David P., Grarup, Niels, Linneberg, Allan, Lee, Young-Ae, Probst-Hensch, Nicole, Weidinger, Stephan, Jarvelin, Marjo-Riitta, Melén, Erik, Hakonarson, Hakon, Irvine, Alan D., Jarvis, Deborah, Nijsten, Tamar, Duijts, Liesbeth, Vonk, Judith M., Koppelmann, Gerard H., Godfrey, Keith M., Barton, Sheila J., Feenstra, Bjarke, Pennell, Craig E., Sly, Peter D., Holt, Patrick G., Williams, L. Keoki, Bisgaard, Hans, Bønnelykke, Klaus, Curtin, John, Simpson, Angela, Murray, Clare, Schikowski, Tamara, Bunyavanich, Supinda, Weiss, Scott T., Holloway, John W., Min, Josine L., Brown, Sara J., Standl, Marie, and Paternoster, Lavinia

Published
2023
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8. Mixed evidence on the relationship between socioeconomic position and atopic dermatitis: A systematic review.

Author

Bajwa, Harsimran, Baghchechi, Mohsen, Mujahid, Mahasin, Kang Dufour, Mi-Suk, Langan, Sinéad M, and Abuabara, Katrina

Subjects
Humans, Dermatitis, Atopic, Prevalence, Socioeconomic Factors, Child, Europe, atopic, dermatitis, eczema, socioeconomic position, socioeconomic status, Prevention, Behavioral and Social Science, Clinical Sciences, Dermatology & Venereal Diseases
Abstract

BackgroundLower socioeconomic position usually portends worse health outcomes, but multiple studies have found that atopic dermatitis is associated with higher socioeconomic position. The nature of this relationship remains unclear.ObjectiveTo systematically review the literature on socioeconomic position and atopic dermatitis and determine whether the association varies by patient or study characteristics.MethodsA literature search was conducted in the PubMed and Embase databases. Individual-level studies addressing the association between all measures of socioeconomic position and the prevalence or incidence of atopic dermatitis were eligible for inclusion. Two independent reviewers screened all texts and extracted all data for qualitative synthesis.ResultsEighty-eight studies met the inclusion criteria. Of the 88 studies, 42% (37) found a positive association between atopic dermatitis and socioeconomic position, 15% (13) found a negative association, and 43% (38) found a null or inconsistent association. Studies conducted in Europe, among children, and based on self-report of eczema were more likely to find a positive association with socioeconomic position.LimitationsStudies varied both in terms of the measurement of socioeconomic position and the definition of atopic dermatitis, limiting quantitative synthesis.ConclusionThe evidence of a positive association between atopic dermatitis and socioeconomic position is not consistent.

Published
2022

9. Phenotypic overlap between atopic dermatitis and autism

Author

Shin, Kyong-Oh, Crumrine, Debra A, Kim, Sungeun, Lee, Yerin, Kim, Bogyeong, Abuabara, Katrina, Park, Chaehyeong, Uchida, Yoshikazu, Wakefield, Joan S, Meyer, Jason M, Jeong, Sekyoo, Park, Byeong Deog, Park, Kyungho, and Elias, Peter M

Subjects
Biological Psychology, Biomedical and Clinical Sciences, Psychology, Behavioral and Social Science, Brain Disorders, Neurosciences, Autism, Pediatric, Intellectual and Developmental Disabilities (IDD), Mental Health, Aetiology, 2.1 Biological and endogenous factors, Neurological, Skin, Animals, Anticonvulsants, Autistic Disorder, Dermatitis, Atopic, Female, Inflammation Mediators, Maze Learning, Mice, Mice, Inbred BALB C, Phenotype, Pregnancy, Prenatal Exposure Delayed Effects, Valproic Acid, Atopic dermatitis, Autism spectrum disorders, Blood-brain barrier, IFN gamma, IL-4, 5, 13 and 17A, TNF alpha, Valproic acid mouse model, Blood–brain barrier, IFNγ, TNFα, Biochemistry and Cell Biology, Cognitive Sciences, Neurology & Neurosurgery, Biological psychology
Abstract

BackgroundAutism, a childhood behavioral disorder, belongs to a large suite of diseases, collectively referred to as autism spectrum disorders (ASD). Though multifactorial in etiology, approximately 10% of ASD are associated with atopic dermatitis (AD). Moreover, ASD prevalence increases further as AD severity worsens, though these disorders share no common causative mutations. We assessed here the link between these two disorders in the standard, valproic acid mouse model of ASD. In prior studies, there was no evidence of skin involvement, but we hypothesized that cutaneous involvement could be detected in experiments conducted in BALB/c mice. BALB/c is an albino, laboratory-bred strain of the house mouse and is among the most widely used inbred strains used in animal experimentation.MethodsWe performed our studies in valproic acid (VPA)-treated BALB/c hairless mice, a standard mouse model of ASD. Mid-trimester pregnant mice received a single intraperitoneal injection of either valproic acid sodium salt dissolved in saline or saline alone on embryonic day 12.5 and were housed individually until postnatal day 21. Only the brain and epidermis appeared to be affected, while other tissues remain unchanged. At various postnatal time points, brain, skin and blood samples were obtained for histology and for quantitation of tissue sphingolipid content and cytokine levels.ResultsAD-like changes in ceramide content occurred by day one postpartum in both VPA-treated mouse skin and brain. The temporal co-emergence of AD and ASD, and the AD phenotype-dependent increase in ASD prevalence correlated with early appearance of cytokine markers (i.e., interleukin [IL]-4, 5, and 13), as well as mast cells in skin and brain. The high levels of interferon (IFN)γ not only in skin, but also in brain likely account for a significant decline in esterified very-long-chain N-acyl fatty acids in brain ceramides, again mimicking known IFNγ-induced changes in AD.ConclusionBaseline involvement of both AD and ASD could reflect concurrent neuro- and epidermal toxicity, possibly because both epidermis and neural tissues originate from the embryonic neuroectoderm. These studies illuminate the shared susceptibility of the brain and epidermis to a known neurotoxin, suggesting that the atopic diathesis could be extended to include ASD.

Published
2021

10. Patterns of Atopic Eczema Disease Activity From Birth Through Midlife in 2 British Birth Cohorts

Author

Abuabara, Katrina, Ye, Morgan, Margolis, David J, McCulloch, Charles E, Mulick, Amy R, Silverwood, Richard J, Sullivan, Alice, Williams, Hywel C, and Langan, Sinéad M

Subjects
Clinical Research, Genetics, Prevention, Pediatric, 2.3 Psychological, social and economic factors, 2.2 Factors relating to the physical environment, Aetiology, Good Health and Well Being, Adult, Asthma, Birth Cohort, Cohort Studies, Dermatitis, Atopic, Eczema, Female, Humans, Infant, Newborn, Male, Prevalence, Risk Factors, Clinical Sciences, Oncology and Carcinogenesis
Abstract

ImportanceAtopic eczema is characterized by a heterogenous waxing and waning course, with variable age of onset and persistence of symptoms. Distinct patterns of disease activity such as early-onset/resolving and persistent disease have been identified throughout childhood; little is known about patterns into adulthood.ObjectiveThis study aimed to identify subtypes of atopic eczema based on patterns of disease activity through mid-adulthood, to examine whether early life risk factors and participant characteristics are associated with these subtypes, and to determine whether subtypes are associated with other atopic diseases and general health in mid-adulthood.Design, setting, and participantsThis study evaluated members of 2 population-based birth cohorts, the 1958 National Childhood Development Study (NCDS) and the 1970 British Cohort Study (BCS70). Participant data were collected over the period between 1958 and 2016. Data were analyzed over the period between 2018 and 2020.Main outcomes and measuresSubtypes of atopic eczema were identified based on self-reported atopic eczema period prevalence at multiple occasions. These subtypes were the outcome in models of early life characteristics and an exposure variable in models of midlife health.ResultsLatent class analysis identified 4 subtypes of atopic eczema with distinct patterns of disease activity among 15 939 individuals from the NCDS (51.4% male, 75.4% White) and 14 966 individuals from the BCS70 (51.6% male, 78.8% White): rare/no (88% to 91%), decreasing (4%), increasing (2% to 6%), and persistently high (2% to 3%) probability of reporting prevalent atopic eczema with age. Sex at birth and early life factors, including social class, region of residence, tobacco smoke exposure, and breastfeeding, predicted differences between the 3 atopic eczema subtypes and the infrequent/no atopic eczema group, but only female sex differentiated the high and decreasing probability subtypes (odds ratio [OR], 1.99; 95% CI, 1.66-2.38). Individuals in the high subtype were most likely to experience asthma and rhinitis, and those in the increasing subtype were at higher risk of poor self-reported general (OR, 1.29; 95% CI, 1.09-1.53) and mental (OR 1.45; 95% CI, 1.23-1.72) health in midlife.Conclusions and relevanceThe findings of this cohort study suggest that extending the window of observation beyond childhood may reveal clear subtypes of atopic eczema based on patterns of disease activity. A newly identified subtype with increasing probability of activity in adulthood warrants additional attention given observed associations with poor self-reported health in midlife.

Published
2021

11. Association of Atopic Dermatitis and Mental Health Outcomes Across Childhood

Author

Kern, Chloe, Wan, Joy, LeWinn, Kaja Z, Ramirez, Faustine D, Lee, Yong, McCulloch, Charles E, Langan, Sinéad M, and Abuabara, Katrina

Subjects
Prevention, Depression, Behavioral and Social Science, Brain Disorders, Pediatric, Clinical Research, Mental Health, 2.3 Psychological, social and economic factors, Aetiology, Mental health, Good Health and Well Being, Adolescent, Adult, Child, Cohort Studies, Dermatitis, Atopic, Eczema, Humans, Longitudinal Studies, Male, Outcome Assessment, Health Care, Clinical Sciences, Oncology and Carcinogenesis
Abstract

ImportanceResearch has highlighted associations between atopic dermatitis (AD) and mental health conditions in adults. However, literature on the development of mental health comorbidities in children is limited despite the large burden of pediatric AD worldwide.ObjectiveTo examine the association between AD and internalizing behaviors and symptoms of depression at multiple points across childhood and adolescence and to explore potential mediating factors, including asthma/rhinitis, sleep, and inflammation.Design, setting, and participantsThis longitudinal, population-based birth cohort study included children followed up from birth for a mean (SD) duration of 10.0 (2.9) years from the UK Avon Longitudinal Study of Parents and Children. Data were collected from September 6, 1990, to December 31, 2009. Data were analyzed from August 30, 2019, to July 30, 2020.ExposuresAnnual period prevalence of AD assessed at 11 points from 6 months to 18 years of age, measured by standardized questions about flexural dermatitis.Main outcomes and measuresSymptoms of depression, measured using child-reported responses to the Short Moods and Feelings Questionnaire at 5 points from 10 to 18 years of age and internalizing behaviors, measured by maternal report of the Emotional Symptoms subscale of the Strength and Difficulties Questionnaire at 7 points from 4 to 16 years of age.ResultsAmong the 11 181 children included in the analysis (5721 male [51.2%]), the period prevalence of symptoms of depression ranged from 6.0% to 21.6%; for internalizing behaviors, from 10.4% to 16.0%. Although mild to moderate AD was not associated with symptoms of depression, it was associated with internalizing behaviors as early as 4 years of age (mean increased odds of 29%-84% across childhood in adjusted models). Severe AD was associated with symptoms of depression (adjusted odds ratio, 2.38; 95% CI, 1.21-4.72) and internalizing symptoms (adjusted odds ratio, 1.90; 95% CI, 1.14-3.16). Sleep quality mediated some of this association, but it was not explained by differences in sleep duration, asthma/rhinitis, or levels of inflammatory markers (interleukin 6 and C-reactive protein).Conclusions and relevanceWithin this population-based birth cohort study in the UK, severe AD was associated with symptoms of depression and internalizing behaviors throughout childhood and adolescence. Risk of internalizing symptoms was increased even for children with mild AD beginning early in childhood, highlighting the importance of behavioral and mental health awareness in this population.

Published
2021

12. Prenatal and Childhood Tobacco Smoke Exposure Are Associated With Sleep-Disordered Breathing Throughout Early Childhood

Author

Ramirez, Faustine D, Groner, Judith A, Ramirez, Joel L, McEvoy, Cindy T, Owens, Judith A, McCulloch, Charles E, Cabana, Michael D, and Abuabara, Katrina

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Pediatric, Tobacco, Clinical Research, Lung, Prevention, Tobacco Smoke and Health, Sleep Research, Reproductive health and childbirth, Good Health and Well Being, Child, Child, Preschool, Female, Humans, Longitudinal Studies, Pregnancy, Sleep Apnea Syndromes, Snoring, Tobacco Smoke Pollution, United Kingdom, apnea, Avon Longitudinal Study of Parents and Children, secondhand smoke, sleep-disordered breathing, snoring, tobacco smoke, Paediatrics and Reproductive Medicine, Pediatrics, Paediatrics
Abstract

ObjectiveTo determine whether prenatal and childhood tobacco smoke exposure (TSE) are each independently associated with mild sleep-disordered breathing (SDB) symptoms throughout early childhood, and whether the association between childhood TSE and SDB differs according to the level of prenatal exposure.MethodsLongitudinal cohort study, using data from the Avon Longitudinal Study of Parents and Children, a population-based birth cohort from the United Kingdom. Primary exposures were repeated measures of mother-reported prenatal and childhood TSE through age 7 years. Outcomes were mother-reported measures of mild SDB symptoms, including snoring, mouth breathing, and witnessed apnea, repeated annually through age 7 years.ResultsA total of 12,030 children were followed for a median duration of 7 years. About 24.2% were exposed to prenatal tobacco smoke, 46.2% were exposed at least once in childhood, and 20.6% were exposed during both periods. Both prenatal and childhood TSE were associated with SDB symptoms throughout early childhood (adjusted OR [aOR] for any prenatal TSE 1.23; 95% confidence interval [CI] 1.08, 1.40; aOR for any childhood TSE 1.17; 95% CI 1.06, 1.29). We observed a dose-response effect between TSE and SBD symptoms, and found evidence of effect modification for those exposed during both time periods (combined high level exposure both prenatally and during childhood: aOR snoring 2.43 [95% CI 1.50, 3.93], aOR apnea 2.65 [95% CI 1.46, 4.82]).ConclusionsPrenatal and childhood TSE were both independently associated with mild SDB symptoms throughout early childhood in a dose-dependent manner, further supporting the critical importance of maintaining a tobacco-free environment throughout gestation and childhood.

Published
2021

13. Global, regional, and national incidence of six major immune-mediated inflammatory diseases: findings from the global burden of disease study 2019

Author

Wu, Dongze, Jin, Yingzhao, Xing, Yuhan, Abate, Melsew Dagne, Abbasian, Mohammadreza, Abbasi-Kangevari, Mohsen, Abbasi-Kangevari, Zeinab, Abd-Allah, Foad, Abdelmasseh, Michael, Abdollahifar, Mohammad-Amin, Abdulah, Deldar Morad, Abedi, Aidin, Abedi, Vida, Abidi, Hassan, Aboagye, Richard Gyan, Abolhassani, Hassan, Abuabara, Katrina, Abyadeh, Morteza, Addo, Isaac Yeboah, Adeniji, Kayode Nelson, Adepoju, Abiola Victor, Adesina, Miracle Ayomikun, Sakilah Adnani, Qorinah Estiningtyas, Afarideh, Mohsen, Aghamiri, Shahin, Agodi, Antonella, Agrawal, Anurag, Aguilera Arriagada, Constanza Elizabeth, Ahmad, Aqeel, Ahmad, Danish, Ahmad, Sajjad, Ahmad, Sohail, Ahmadi, Ali, Ahmed, Ali, Ahmed, Ayman, Aithala, Janardhana P., Ajadi, Abdullateef Abiodun, Ajami, Marjan, Akbarzadeh-Khiavi, Mostafa, Alahdab, Fares, AlBataineh, Mohammad T., Alemi, Sharifullah, Saeed Al-Gheethi, Adel Ali, Ali, Liaqat, Alif, Sheikh Mohammad, Almazan, Joseph Uy, Almustanyir, Sami, Alqahtani, Jaber S., Alqasmi, Ibrahim, Khan Altaf, Ihsan Ullah, Alvis-Guzman, Nelson, Alvis-Zakzuk, Nelson J., Al-Worafi, Yaser Mohammed, Aly, Hany, Amani, Reza, Amu, Hubert, Amusa, Ganiyu Adeniyi, Andrei, Catalina Liliana, Ansar, Adnan, Ansariniya, Hossein, Anyasodor, Anayochukwu Edward, Arabloo, Jalal, Arefnezhad, Reza, Arulappan, Judie, Asghari-Jafarabadi, Mohammad, Ashraf, Tahira, Atata, Jamila Abdulhamid, Athari, Seyyed Shamsadin, Atlaw, Daniel, Wahbi Atout, Maha Moh'd, Aujayeb, Avinash, Awan, Asma Tahir, Ayatollahi, Haleh, Azadnajafabad, Sina, Azzam, Ahmed Y., Badawi, Alaa, Badiye, Ashish D., Bagherieh, Sara, Baig, Atif Amin, Bantie, Berihun Bantie, Barchitta, Martina, Bardhan, Mainak, Barker-Collo, Suzanne Lyn, Barone-Adesi, Francesco, Batra, Kavita, Bayileyegn, Nebiyou Simegnew, Behnoush, Amir Hossein, Belgaumi, Uzma Iqbal, Bemanalizadeh, Maryam, Bensenor, Isabela M., Beyene, Kebede A., Bhagavathula, Akshaya Srikanth, Bhardwaj, Pankaj, Bhaskar, Sonu, Bhat, Ajay Nagesh, Bitaraf, Saeid, Bitra, Veera R., Boloor, Archith, Bora, Kaustubh, Botelho, João Silva, Buchbinder, Rachelle, Calina, Daniela, Cámera, Luis Alberto, Carvalho, Andre F., Kai Chan, Jeffrey Shi, Chattu, Vijay Kumar, Abebe, Endeshaw Chekol, Chichagi, Fatemeh, Choi, Sungchul, Chou, Tzu-Chieh, Chu, Dinh-Toi, Coberly, Kaleb, Costa, Vera Marisa, Couto, Rosa A.S., Cruz-Martins, Natália, Dadras, Omid, Dai, Xiaochen, Damiani, Giovanni, Dascalu, Ana Maria, Dashti, Mohsen, Debela, Sisay Abebe, Dellavalle, Robert Paul, Demetriades, Andreas K., Demlash, Alemayehu Anley, Deng, Xinlei, Desai, Hardik Dineshbhai, Desai, Rupak, Rahman Dewan, Syed Masudur, Dey, Sourav, Dharmaratne, Samath Dhamminda, Diaz, Daniel, Dibas, Mahmoud, Dinis-Oliveira, Ricardo Jorge, Diress, Mengistie, Do, Thanh Chi, Doan, Duy Khanh, Dodangeh, Masoud, Dodangeh, Milad, Dongarwar, Deepa, Dube, John, Dziedzic, Arkadiusz Marian, Ed-Dra, Abdelaziz, Edinur, Hisham Atan, Eissazade, Negin, Ekholuenetale, Michael, Ekundayo, Temitope Cyrus, Elemam, Noha Mousaad, Elhadi, Muhammed, Elmehrath, Ahmed O., Abdou Elmeligy, Omar Abdelsadek, Emamverdi, Mehdi, Emeto, Theophilus I., Esayas, Hawi Leul, Eshetu, Habitu Birhan, Etaee, Farshid, Fagbamigbe, Adeniyi Francis, Faghani, Shahriar, Fakhradiyev, Ildar Ravisovich, Fatehizadeh, Ali, Fathi, Mobina, Feizkhah, Alireza, Fekadu, Ginenus, Fereidouni, Mohammad, Fereshtehnejad, Seyed-Mohammad, Fernandes, João C., Ferrara, Pietro, Fetensa, Getahun, Filip, Irina, Fischer, Florian, Foroutan, Behzad, Foroutan, Masoud, Fukumoto, Takeshi, Ganesan, Balasankar, Belete Gemeda, Belete Negese, Ghamari, Seyyed-Hadi, Ghasemi, MohammadReza, Gholamalizadeh, Maryam, Gill, Tiffany K., Gillum, Richard F., Goldust, Mohamad, Golechha, Mahaveer, Goleij, Pouya, Golinelli, Davide, Goudarzi, Houman, Guan, Shi-Yang, Guo, Yang, Gupta, Bhawna, Gupta, Veer Bala, Gupta, Vivek Kumar, Haddadi, Rasool, Hadi, Najah R., Halwani, Rabih, Haque, Shafiul, Hasan, Ikramul, Hashempour, Reza, Hassan, Amr, Hassan, Treska S., Hassanzadeh, Sara, Hassen, Mohammed Bheser, Haubold, Johannes, Hayat, Khezar, Heidari, Golnaz, Heidari, Mohammad, Heidari-Soureshjani, Reza, Herteliu, Claudiu, Hessami, Kamran, Hezam, Kamal, Hiraike, Yuta, Holla, Ramesh, Hosseini, Mohammad-Salar, Huynh, Hong-Han, Hwang, Bing-Fang, Ibitoye, Segun Emmanuel, Ilic, Irena M., Ilic, Milena D., Iranmehr, Arad, Iravanpour, Farideh, Ismail, Nahlah Elkudssiah, Iwagami, Masao, Iwu, Chidozie C.D., Jacob, Louis, Jafarinia, Morteza, Jafarzadeh, Abdollah, Jahankhani, Kasra, Jahrami, Haitham, Jakovljevic, Mihajlo, Jamshidi, Elham, Jani, Chinmay T., Janodia, Manthan Dilipkumar, Jayapal, Sathish Kumar, Jayaram, Shubha, Jeganathan, Jayakumar, Jonas, Jost B., Joseph, Abel, Joseph, Nitin, Joshua, Charity Ehimwenma, Vaishali, K., Kaambwa, Billingsley, Kabir, Ali, Kabir, Zubair, Kadashetti, Vidya, Kaliyadan, Feroze, Kalroozi, Fatemeh, Kamal, Vineet Kumar, Kandel, Amit, Kandel, Himal, Kanungo, Srikanta, Karami, Jafar, Karaye, Ibraheem M., Karimi, Hanie, Kasraei, Hengameh, Kazemian, Sina, Kebede, Sewnet Adem, Keikavoosi-Arani, Leila, Keykhaei, Mohammad, Khader, Yousef Saleh, Khajuria, Himanshu, Khamesipour, Faham, Khan, Ejaz Ahmad, Khan, Imteyaz A., Khan, Maseer, Khan, Md Jobair, Khan, Moien A.B., Khan, Muhammad Arslan, Khatatbeh, Haitham, Khatatbeh, Moawiah Mohammad, Khateri, Sorour, Khayat Kashani, Hamid Reza, Kim, Min Seo, Kisa, Adnan, Kisa, Sezer, Koh, Hyun Yong, Kolkhir, Pavel, Korzh, Oleksii, Kotnis, Ashwin Laxmikant, Koul, Parvaiz A., Koyanagi, Ai, Krishan, Kewal, Kuddus, Mohammed, Kulkarni, Vishnutheertha Vishnutheertha, Kumar, Narinder, Kundu, Satyajit, Kurmi, Om P., La Vecchia, Carlo, Lahariya, Chandrakant, Laksono, Tri, Lám, Judit, Latief, Kamaluddin, Lauriola, Paolo, Lawal, Basira Kankia, Thu Le, Thao Thi, Bich Le, Trang Thi, Lee, Munjae, Lee, Seung Won, Lee, Wei-Chen, Lee, Yo Han, Lenzi, Jacopo, Levi, Miriam, Li, Wei, Ligade, Virendra S., Lim, Stephen S., Liu, Gang, Liu, Xuefeng, Llanaj, Erand, Lo, Chun-Han, Machado, Vanessa Sintra, Maghazachi, Azzam A., Mahmoud, Mansour Adam, Mai, Tuan A., Majeed, Azeem, Sanaye, Pantea Majma, Makram, Omar Mohamed, Rad, Elaheh Malakan, Malhotra, Kashish, Malik, Ahmad Azam, Malik, Iram, Mallhi, Tauqeer Hussain, Malta, Deborah Carvalho, Mansournia, Mohammad Ali, Mantovani, Lorenzo Giovanni, Martorell, Miquel, Masoudi, Sahar, Masoumi, Seyedeh Zahra, Mathangasinghe, Yasith, Mathews, Elezebeth, Mathioudakis, Alexander G., Maugeri, Andrea, Mayeli, Mahsa, Carabeo Medina, John Robert, Meles, Gebrekiros Gebremichael, Mendes, José João, Menezes, Ritesh G., Mestrovic, Tomislav, Michalek, Irmina Maria, Micheletti Gomide Nogueira de Sá, Ana Carolina, Mihretie, Ephrem Tesfaye, Nhat Minh, Le Huu, Mirfakhraie, Reza, Mirrakhimov, Erkin M., Misganaw, Awoke, Mohamadkhani, Ashraf, Mohamed, Nouh Saad, Mohammadi, Faezeh, Mohammadi, Soheil, Mohammed, Salahuddin, Mohammed, Shafiu, Mohan, Syam, Mohseni, Anita, Mokdad, Ali H., Momtazmanesh, Sara, Monasta, Lorenzo, Moni, Mohammad Ali, Moniruzzaman, Md, Moradi, Yousef, Morovatdar, Negar, Mostafavi, Ebrahim, Mousavi, Parsa, Mukoro, George Duke, Mulita, Admir, Mulu, Getaneh Baye, Murillo-Zamora, Efrén, Musaigwa, Fungai, Mustafa, Ghulam, Muthu, Sathish, Nainu, Firzan, Nangia, Vinay, Swamy, Sreenivas Narasimha, Natto, Zuhair S., Navaraj, Perumalsamy, Nayak, Biswa Prakash, Nazri-Panjaki, Athare, Negash, Hadush, Nematollahi, Mohammad Hadi, Nguyen, Dang H., Hien Nguyen, Hau Thi, Nguyen, Hien Quang, Nguyen, Phat Tuan, Nguyen, Van Thanh, Niazi, Robina Khan, Nikolouzakis, Taxiarchis Konstantinos, Nnyanzi, Lawrence Achilles, Noreen, Mamoona, Nzoputam, Chimezie Igwegbe, Nzoputam, Ogochukwu Janet, Oancea, Bogdan, Oh, In-Hwan, Okati-Aliabad, Hassan, Okonji, Osaretin Christabel, Okwute, Patrick Godwin, Olagunju, Andrew T., Olatubi, Matthew Idowu, Olufadewa, Isaac Iyinoluwa, Ordak, Michal, Otstavnov, Nikita, Owolabi, Mayowa O., Mahesh, P.A., Padubidri, Jagadish Rao, Pak, Anton, Pakzad, Reza, Palladino, Raffaele, Pana, Adrian, Pantazopoulos, Ioannis, Papadopoulou, Paraskevi, Pardhan, Shahina, Parthasarathi, Ashwaghosha, Pashaei, Ava, Patel, Jay, Pathan, Aslam Ramjan, Patil, Shankargouda, Paudel, Uttam, Pawar, Shrikant, Pedersini, Paolo, Pensato, Umberto, Pereira, David M., Pereira, Jeevan, Pereira, Maria Odete, Pereira, Renato B., Peres, Mario F.P., Perianayagam, Arokiasamy, Perna, Simone, Petcu, Ionela-Roxana, Pezeshki, Parmida Sadat, Pham, Hoang Tran, Philip, Anil K., Piradov, Michael A., Podder, Indrashis, Podder, Vivek, Poddighe, Dimitri, Sady Prates, Elton Junio, Qattea, Ibrahim, Radfar, Amir, Raee, Pourya, Rafiei, Alireza, Raggi, Alberto, Rahim, Fakher, Rahimi, Mehran, Rahimifard, Mahban, Rahimi-Movaghar, Vafa, Rahman, Md Obaidur, Ur Rahman, Mohammad Hifz, Rahman, Mosiur, Rahman, Muhammad Aziz, Rahmani, Amir Masoud, Rahmani, Mohamed, Rahmani, Shayan, Rahmanian, Vahid, Ramasubramani, Premkumar, Rancic, Nemanja, Rao, Indu Ramachandra, Rashedi, Sina, Rashid, Ahmed Mustafa, Ravikumar, Nakul, Rawaf, Salman, Mohamed Redwan, Elrashdy Moustafa, Rezaei, Nazila, Rezaei, Negar, Rezaei, Nima, Rezaeian, Mohsen, Ribeiro, Daniela, Rodrigues, Mónica, Buendia Rodriguez, Jefferson Antonio, Roever, Leonardo, Romero-Rodríguez, Esperanza, Saad, Aly M.A., Saddik, Basema, Sadeghian, Saeid, Saeed, Umar, Safary, Azam, Safdarian, Mahdi, Safi, Sher Zaman, Saghazadeh, Amene, Sagoe, Dominic, Sharif-Askari, Fatemeh Saheb, Sharif-Askari, Narjes Saheb, Sahebkar, Amirhossein, Sahoo, Harihar, Sahraian, Mohammad Ali, Sajid, Mirza Rizwan, Sakhamuri, Sateesh, Sakshaug, Joseph W., Saleh, Mohamed A., Salehi, Leili, Salehi, Sana, Farrokhi, Amir Salek, Samadzadeh, Sara, Samargandy, Saad, Samieefar, Noosha, Samy, Abdallah M., Sanadgol, Nima, Sanjeev, Rama Krishna, Sawhney, Monika, Saya, Ganesh Kumar, Schuermans, Art, Senthilkumaran, Subramanian, Sepanlou, Sadaf G., Sethi, Yashendra, Shafie, Mahan, Shah, Humaira, Shahid, Izza, Shahid, Samiah, Shaikh, Masood Ali, Sharfaei, Sadaf, Sharma, Manoj, Shayan, Maryam, Shehata, Hatem Samir, Sheikh, Aziz, Shetty, Jeevan K., Shin, Jae Il, Shirkoohi, Reza, Shitaye, Nebiyu Aniley, Shivakumar, K.M., Shivarov, Velizar, Shobeiri, Parnian, Siabani, Soraya, Sibhat, Migbar Mekonnen, Siddig, Emmanuel Edwar, Simpson, Colin R., Sinaei, Ehsan, Singh, Harpreet, Singh, Inderbir, Singh, Jasvinder A., Singh, Paramdeep, Singh, Surjit, Siraj, Md Shahjahan, Al Mamun Sohag, Abdullah, Solanki, Ranjan, Solikhah, Solikhah, Solomon, Yonatan, Soltani-Zangbar, Mohammad Sadegh, Sun, Jing, Szeto, Mindy D., Tabarés-Seisdedos, Rafael, Tabatabaei, Seyyed Mohammad, Tabish, Mohammad, Taheri, Ensiyeh, Tahvildari, Azin, Talaat, Iman M., Lukenze Tamuzi, Jacques J.L., Tan, Ker-Kan, Tat, Nathan Y., Oliaee, Razieh Tavakoli, Tavasol, Arian, Temsah, Mohamad-Hani, Thangaraju, Pugazhenthan, Tharwat, Samar, Tibebu, Nigusie Selomon, Vera Ticoalu, Jansje Henny, Tillawi, Tala, Tiruye, Tenaw Yimer, Tiyuri, Amir, Tovani-Palone, Marcos Roberto, Tripathi, Manjari, Tsegay, Guesh Mebrahtom, Tualeka, Abdul Rohim, Ty, Sree Sudha, Ubah, Chukwudi S., Ullah, Saif, Ullah, Sana, Umair, Muhammad, Umakanthan, Srikanth, Upadhyay, Era, Vahabi, Seyed Mohammad, Vaithinathan, Asokan Govindaraj, Tahbaz, Sahel Valadan, Valizadeh, Rohollah, Varthya, Shoban Babu, Vasankari, Tommi Juhani, Venketasubramanian, Narayanaswamy, Verras, Georgios-Ioannis, Villafañe, Jorge Hugo, Vlassov, Vasily, Vo, Danh Cao, Waheed, Yasir, Waris, Abdul, Welegebrial, Brhane Gebrehiwot, Westerman, Ronny, Wickramasinghe, Dakshitha Praneeth, Wickramasinghe, Nuwan Darshana, Willekens, Barbara, Woldegeorgis, Beshada Zerfu, Woldemariam, Melat, Xiao, Hong, Yada, Dereje Y., Yahya, Galal, Yang, Lin, Yazdanpanah, Fereshteh, Yon, Dong Keon, Yonemoto, Naohiro, You, Yuyi, Zahir, Mazyar, Zaidi, Syed Saoud, Zangiabadian, Moein, Zare, Iman, Zeineddine, Mohammad A., Zemedikun, Dawit T., Zeru, Naod Gebrekrstos, Zhang, Chen, Zhao, Hanqing, Zhong, Chenwen, Zielińska, Magdalena, Zoladl, Mohammad, Zumla, Alimuddin, Guo, Cui, and Tam, Lai-shan

Published
2023
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14. The epidemiology of atopic dermatitis in older adults: A population-based study in the United Kingdom

Author

Chan, Leslie N, Magyari, Alexa, Ye, Morgan, Al-Alusi, Noor A, Langan, Sinead M, Margolis, David, McCulloch, Charles E, and Abuabara, Katrina

Subjects
Health Services and Systems, Biomedical and Clinical Sciences, Public Health, Health Sciences, Clinical Research, Pediatric, Aging, Aetiology, 2.4 Surveillance and distribution, Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Child, Child, Preschool, Dermatitis, Atopic, Female, Humans, Infant, Infant, Newborn, Logistic Models, Male, Middle Aged, Multivariate Analysis, Prevalence, Severity of Illness Index, United Kingdom, Young Adult, General Science & Technology
Abstract

BackgroundAtopic dermatitis is known to be common among children, but there are few studies examining the epidemiology across the life course. In particular, there is a paucity of data on atopic dermatitis among older adults.ObjectiveTo evaluate participant characteristics, patterns of disease activity and severity, and calendar trends in older adult atopic dermatitis in comparison to other age groups in a large population-based cohort.MethodsThis was a cohort study of 9,154,936 individuals aged 0-99 years registered in The Health Improvement Network, a database comprised of electronic health records from general practices in the United Kingdom between 1994 and 2013. Atopic dermatitis was defined by a previously validated algorithm using a combination of at least one recorded atopic dermatitis diagnostic code in primary care and two atopic dermatitis therapies recorded on separate days. Cross-sectional analyses of disease prevalence were conducted at each age. Logistic mixed effect regression models were used to identify predictors of prevalent disease over time among children (0-17 years), adults (18-74 years), and older adults (75-99 years).ResultsPhysician-diagnosed atopic dermatitis was identified in 894,454 individuals with the following proportions in each age group: 18.3% of children, 7.7% of adults, and 11.6% of older adults. Additionally, atopic dermatitis prevalence increased across the 2-decade period (beta from linear regression test for trend in the change in proportion per year = 0.005, p = 0.044). In older adults, atopic dermatitis was 27% less common among females (adjusted OR 0.73, 95% CI 0.70-0.76) and was more likely to be active (59.7%, 95% CI 59.5-59.9%) and of higher severity (mean annual percentage with moderate and severe disease: 31.8% and 3.0%, respectively) than in other age groups.ConclusionIn a large population-based cohort, the prevalence of physician-diagnosed atopic dermatitis has increased throughout adulthood and was most common among males age 75 years and above. Compared to children ages 0-17 and adults ages 18-74, older adult atopic dermatitis was more active and severe. Because the prevalence of atopic dermatitis among older adults has increased over time, additional characterization of disease triggers and mechanisms and targeted treatment recommendations are needed for this population.

Published
2021

15. International observational atopic dermatitis cohort to follow natural history and treatment course: TARGET-DERM AD study design and rationale.

Author

Abuabara, Katrina, Silverberg, Jonathan I, Simpson, Eric L, Paller, Amy S, Eichenfield, Lawrence F, Bissonnette, Robert, Krueger, James, Harris, John E, Dalfonso, Laura, Watkins, Stephanie E, Crawford, Julie M, Thaçi, D, and Guttman-Yassky, Emma

Subjects
eczema, medical history, statistics & research methods, therapeutics, statistics &amp, research methods, Clinical Sciences, Public Health and Health Services, Other Medical and Health Sciences
Abstract

IntroductionAs new topical and systemic treatments become available for atopic dermatitis (AD), there is a need to understand how treatments are being used in routine clinical practice, their comparative effectiveness and their long-term safety in diverse clinical settings.Methods and analysisThe TARGET-DERM AD cohort is a longitudinal, observational study of patients with AD of all ages, designed to provide practical information on long-term effectiveness and safety unobtainable in traditional registration trials. Patients with physician-diagnosed AD receiving prescription treatment (topical or systemic) will be enrolled at academic and community clinical centres. Up to 3 years of retrospective medical records, 5 years of prospective medical records, and optional biological samples and patient-reported outcomes will be collected. The primary aims include characterisation of AD treatment regimens, evaluation of response to therapy, and description of adverse events.Ethics and disseminationTARGET-DERM has been approved by a central IRB (Copernicus Group IRB, 5000 Centregreen Way Suite 200, Cary, North Carolina 27513) as well as local and institutional IRBs. No additional Ethics Committee reviews. Results will be reviewed by a publications committee and submitted to peer-reviewed journals.Trial registration numberNCT03661866, pre-results.

Published
2020

16. Atopic Eczema in Adulthood and Risk of Depression and Anxiety: A Population-Based Cohort Study

Author

Schonmann, Yochai, Mansfield, Kathryn E, Hayes, Joseph F, Abuabara, Katrina, Roberts, Amanda, Smeeth, Liam, and Langan, Sinéad M

Subjects
Prevention, Behavioral and Social Science, Mental Health, Brain Disorders, Depression, Mental health, Adult, Anxiety, Anxiety Disorders, Cohort Studies, Dermatitis, Atopic, Eczema, Humans, Atopic eczema, Atopic dermatitis, Population-based, Severity
Abstract

BackgroundAtopic eczema is a common and debilitating condition associated with depression and anxiety, but the nature of this association remains unclear.ObjectiveTo explore the temporal relationship between atopic eczema and new depression/anxiety.MethodsThis matched cohort study used routinely collected data from the UK Clinical Practice Research Datalink, linked to hospital admissions data. We identified adults with atopic eczema (1998-2016) using a validated algorithm, and up to 5 individuals without atopic eczema matched on date of diagnosis, age, sex, and general practice. We estimated the hazard ratio (HR) for new depression/anxiety using stratified Cox regression to account for age, sex, calendar period, Index of Multiple Deprivation, glucocorticoid treatment, obesity, smoking, and harmful alcohol use.ResultsWe identified 526,808 adults with atopic eczema who were matched to 2,569,030 without. Atopic eczema was associated with increased incidence of new depression (HR, 1.14; 99% CI, 1.12-1.16) and anxiety (HR, 1.17; 99% CI, 1.14-1.19). We observed a stronger effect of atopic eczema on depression with increasing atopic eczema severity (HR [99% CI] compared with no atopic eczema: mild, 1.10 [1.08-1.13]; moderate, 1.19 [1.15-1.23]; and severe, 1.26 [1.17-1.37]). A dose-response association, however, was less apparent for new anxiety diagnosis (HR [99% CI] compared with no atopic eczema: mild, 1.14 [1.11-1.18]; moderate, 1.21 [1.17-1.26]; and severe, 1.15; [1.05-1.25]).ConclusionsAdults with atopic eczema are more likely to develop new depression and anxiety. For depression, we observed a dose-response relationship with atopic eczema severity.

Published
2020

17. By protecting against cutaneous inflammation, epidermal pigmentation provided an additional advantage for ancestral humans

Author

Lin, Tzu‐Kai, Man, Mao‐Qiang, Abuabara, Katrina, Wakefield, Joan S, Sheu, Hamm‐ming, Tsai, Jui‐chen, Lee, Chih‐Hung, and Elias, Peter M

Subjects
Biological Sciences, Ecology, Evolutionary Biology, Genetics, Aetiology, 2.1 Biological and endogenous factors, Inflammatory and immune system, barrier function, epidermis, evolution, inflammation, melanin, pH, pigmentation, Medicinal and Biomolecular Chemistry, Evolutionary biology
Abstract

Pigmentation evolved in ancestral humans to protect against toxic, ultraviolet B irradiation, but the question remains: "what is being protected?" Because humans with dark pigmentation display a suite of superior epidermal functions in comparison with their more lightly pigmented counterparts, we hypothesized and provided evidence that dark pigmentation evolved in Africa to support cutaneous function. Because our prior clinical studies also showed that a restoration of a competent barrier dampens cutaneous inflammation, we hypothesized that resistance to inflammation could have provided pigmented hominins with yet another, important evolutionary benefit. We addressed this issue here in two closely related strains of hairless mice, endowed with either moderate (Skh2/J) or absent (Skh1) pigmentation. In these models, we showed that (a) pigmented mice display a markedly reduced propensity to develop inflammation after challenges with either a topical irritant or allergen in comparison with their nonpigmented counterparts; (b) visible and histologic evidence of inflammation was paralleled by reduced levels of pro-inflammatory cytokines (i.e., IL-1α and INFα); (c) because depigmentation of Skh2/J mouse skin enhanced both visible inflammation and pro-inflammatory cytokine levels after comparable pro-inflammatory challenges, the reduced propensity to develop inflammation was directly linked to the presence of pigmentation; and (d) furthermore, in accordance with our prior work showing that pigment production endows benefits by reducing the surface pH of skin, acidification of albino (Skh1) mouse skin also protected against inflammation, and equalized cytokine levels to those found in pigmented skin. In summary, pigmentation yields a reduced propensity to develop inflammation, consistent with our hypothesis that dark pigmentation evolved in ancestral humans to provide a suite of barrier-linked benefits that now include resistance to inflammation.

Published
2019

18. Clinical onset of atopic eczema: Results from 2 nationally representative British birth cohorts followed through midlife.

Author

Abuabara, Katrina, Ye, Morgan, McCulloch, Charles E, Sullivan, Alice, Margolis, David J, Strachan, David P, Paternoster, Lavinia, Yew, Yik Weng, Williams, Hywel C, and Langan, Sinéad M

Subjects
Humans, Dermatitis, Atopic, Cohort Studies, Longitudinal Studies, Adolescent, Adult, Middle Aged, Child, Child, Preschool, Infant, Infant, Newborn, England, Female, Male, Young Adult, Self Report, Filaggrin Proteins, Atopic eczema, atopic dermatitis, epidemiology, natural history, Clinical Research, Pediatric, Prevention, 2.3 Psychological, social and economic factors, Aetiology, 2.1 Biological and endogenous factors, 2.4 Surveillance and distribution, Skin, Immunology, Allergy
Abstract

BackgroundAtopic eczema onset is described primarily in early childhood, and the frequency and characteristics of adult-onset disease remain controversial.ObjectiveWe sought to determine the proportion of subjects who report atopic eczema symptoms between birth and midadulthood and to examine demographic, immunologic, and genetic factors associated with period of symptom onset.MethodsWe conducted a longitudinal study using data from 2 nationally representative community-based birth cohorts from the United Kingdom: the British Cohort Studies 1958 and 1970. Subjects were followed from birth through age 42 to 50 years. The primary outcome was the age period of self-reported atopic eczema symptom onset based on repeated measures of self-reported atopic eczema at each survey wave.ResultsThe annual period prevalence of atopic eczema ranged from 5% to 15% in 2 cohorts of more than 17,000 participants each followed from birth through middle age. There was no clear trend in prevalence by age, and among adults reporting active atopic eczema during a given year, only 38% had symptom onset reported in childhood. When compared with subjects whose eczema started in childhood, those with adult-onset disease were more likely to be women, from Scotland or Northern England, of lower childhood socioeconomic group, smokers in adulthood, and less likely to have a history of asthma. In a subanalysis using data from the 1958 cohort only, genetic mutations previously associated with atopic eczema, including filaggrin-null mutations, and allergen-specific IgE were more common among those with childhood-onset disease.ConclusionRates of self-reported atopic eczema remain high after childhood, and adult-onset atopic eczema has different risk factor associations than childhood-onset eczema.

Published
2019

19. Atopic eczema and major cardiovascular outcomes: A systematic review and meta-analysis of population-based studies

Author

Ascott, Anna, Mulick, Amy, Yu, Ashley M, Prieto-Merino, David, Schmidt, Morten, Abuabara, Katrina, Smeeth, Liam, Roberts, Amanda, and Langan, Sinéad M

Subjects
Cardiovascular, Heart Disease, Heart Disease - Coronary Heart Disease, Prevention, Skin, Stroke, Good Health and Well Being, Bayes Theorem, Cardiovascular Diseases, Cohort Studies, Cross-Sectional Studies, Dermatitis, Atopic, Humans, Population Groups, Atopic eczema, atopic dermatitis, angina, myocardial infarction, heart failure, stroke, ischemic stroke, cardiovascular death, cardiovascular outcomes, risk factors, Immunology, Allergy
Abstract

BackgroundAtopic eczema is a common inflammatory skin disease. Various inflammatory conditions have been linked to cardiovascular disease, a major cause of global mortality and morbidity.ObjectiveWe sought to systematically review and meta-analyze population-based studies assessing associations between atopic eczema and specific cardiovascular outcomes.MethodsMEDLINE, Embase, and Global Health were searched from inception to December 2017. We obtained pooled estimates using random-effects meta-analyses. We used a multivariate Bayesian meta-regression model to estimate the slope of effect of increasing atopic eczema severity on cardiovascular outcomes.ResultsNineteen relevant studies were included. The effects of atopic eczema reported in cross-sectional studies were heterogeneous, with no evidence for pooled associations with angina, myocardial infarction, heart failure, or stroke. In cohort studies atopic eczema was associated with increased risk of myocardial infarction (n = 4; relative risk [RR], 1.12; 95% CI, 1.00-1.25), stroke (n = 4; RR, 1.10; 95% CI, 1.03-1.17), ischemic stroke n = 4; RR, 1.17; 95% CI, 1.14-1.20), angina (n = 2; RR, 1.18; 95% CI, 1.13-1.24), and heart failure (n = 2; RR, 1.26; 95% CI, 1.05-1.51). Prediction intervals were wide for myocardial infarction and stroke. The risk of cardiovascular outcomes appeared to increase with increasing severity (mean RR increase between severity categories, 1.15; 95% credibility interval, 1.09-1.21; uncertainty interval, 1.04-1.28).ConclusionSignificant associations with cardiovascular outcomes were more common in cohort studies but with considerable between-study heterogeneity. Increasing atopic eczema severity was associated with increased risk of cardiovascular outcomes. Improved awareness among stakeholders regarding this small but significant association is warranted.

Published
2019

20. Assessment of Sleep Disturbances and Exhaustion in Mothers of Children With Atopic Dermatitis.

Author

Ramirez, Faustine D, Chen, Shelley, Langan, Sinéad M, Prather, Aric A, McCulloch, Charles E, Kidd, Sharon A, Cabana, Michael D, Chren, Mary-Margaret, and Abuabara, Katrina

Subjects
Humans, Dermatitis, Atopic, Severity of Illness Index, Cohort Studies, Longitudinal Studies, Mothers, Adult, Child, Child, Preschool, Infant, Infant, Newborn, Female, Male, Young Adult, Sleep Wake Disorders, United Kingdom, Prevention, Sleep Research, Clinical Research, Clinical Trials and Supportive Activities, Pediatric, Behavioral and Social Science, Good Health and Well Being, Clinical Sciences, Oncology and Carcinogenesis
Abstract

ImportanceThe well-being and development of children is strongly influenced by parents' physical and psychosocial health. Data from small, clinic-based studies suggest that sleep loss may be common in parents of children with atopic dermatitis (AD), but longitudinal population-based studies are lacking.ObjectivesTo compare sleep disturbances over time between mothers of children with and without AD and to determine whether these disturbances are associated with the child's disease severity and the child's sleep disturbances.Design, setting, and participantsIn the ongoing Avon Longitudinal Study of Parents and Children, all pregnant women residing in Avon, United Kingdom, with an expected delivery date between April 1, 1991, and December 31, 1992, were recruited. Analyses for this study, a secondary analysis of this cohort, were performed from September 2017 to September 2018. Mother-child pairs were followed up with a time-varying measure of child AD activity and severity and self-reported maternal sleep measures repeated at multiple time points between child ages 6 months and 11 years.Main outcomes and measuresTime-varying binary measures of maternal sleep duration (

Published
2019

21. Classifying atopic dermatitis: protocol for a systematic review of subtypes (phenotypes) and associated characteristics.

Author

Mulick, Amy R, Allen, Victoria, Williams, Hywel C, Grindlay, Douglas JC, Pearce, Neil, Abuabara, Katrina, and Langan, Sinéad M

Subjects
Humans, Dermatitis, Atopic, Prognosis, Phenotype, Research Design, Systematic Reviews as Topic, atopic dermatitis, classification, eczema, phenotype, Dermatitis, Atopic, Clinical Sciences, Public Health and Health Services, Other Medical and Health Sciences
Abstract

IntroductionAtopic dermatitis is a complex disease with differing clinical presentations. Many attempts have been made to identify uniform subtypes, or phenotypes, of atopic dermatitis in order to identify different aetiologies, improve diagnosis, estimate more accurate clinical prognoses, inform treatment andmanagement or predict treatment efficacy andeffectiveness. However, no consensus yet exists on exactly what defines these phenotypes or how many there are and whether they are genuine or statistical artefacts. This review aims to identify previously reported phenotypes of atopic dermatitis, the features used to define them and any characteristics or clinical outcomes significantly associated with them.Methods and analysisWe will search Ovid Embase, Ovid MEDLINE and Web of Science from inception to the latest available date at the time of the search for studies attempting to classify atopic dermatitis in humans using any cross-sectional or longitudinal epidemiological or interventional design. Primary outcomes are atopic dermatitis phenotypes, features used to define them and characteristics associated with them in subsequent analyses. A secondary outcome is the methodological approach used to derive them. Two reviewers will independently screen titles and abstracts for inclusion, extract data and assess study quality. We will present the results of this review descriptively and with frequencies where possible.Ethics and disseminationEthical approval is not required for this study as it is a systematic review. We will report results from this systematic review in a peer-reviewed journal. The main value of this study will be to inform further research.Prospero registration numberCRD42018087500.

Published
2018

22. Association between childhood allergic diseases, educational attainment and occupational status in later life: systematic review protocol.

Author

von Kobyletzki, Laura Beate, Beckman, Linda, Smeeth, Liam, McKee, Martin, Quint, Jennifer K, Abuabara, Katrina, and Langan, Sinead

Subjects
Humans, Hypersensitivity, Causality, Research Design, Adolescent, Child, Employment, Academic Success, Systematic Reviews as Topic, allergic rhinitis, allergy, asthma, eczema, food hypersensitivity, systematic review, Clinical Sciences, Public Health and Health Services, Other Medical and Health Sciences
Abstract

IntroductionChildhood allergic diseases may prevent affected children from achieving their academic potential. Potential mechanisms include absence from school due to illness and medical appointments. Experience of symptoms in classes or leisure time, and stigma associated with visible signs and symptoms, including skin disease, requirements for medication during school time or the need for specific diets, may also contribute to reduced educational attainment. Studies have investigated the association between specific allergic diseases and educational attainment. The aim of this study is to systematically review the literature on allergic diseases, educational attainment and occupational status, and if possible, calculate meta-analytic summary estimates for the associations.MethodsSystematic electronic searches in Medline, EMBASE, Cochrane, Cumulative Index to Nursing & Allied Health Literature (CINAHL), PsycINFO and education Resources Information Center (ERIC); hand search in reference lists of included papers and conference reports; search for unpublished studies in clinical trial registers and the New York Academy of Medicine Grey Literature Report; data extraction; and study quality assessment (Newcastle-Ottawa Scale) will be performed.AnalysisData will be summarised descriptively, and meta-analysis including meta-regression to explore sources of heterogeneities will be performed if possible.Ethics and disseminationDissemination in a peer-reviewed, open-access, international scientific journal is planned.Prospero registration numberCRD42017058036.

Published
2017

23. Association between eczema and major cardiovascular outcomes in population-based studies: a systematic review protocol.

Author

Ascott, Anna, Yu, Ashley M, Schmidt, Morten, Abuabara, Katrina, Smeeth, Liam, and Langan, Sinéad M

Subjects
Humans, Cardiovascular Diseases, Eczema, Risk Factors, Research Design, Systematic Reviews as Topic, cardiac epidemiology, cardiology, dermatological epidemiology, dermatology, eczema, epidemiology, Clinical Sciences, Public Health and Health Services, Other Medical and Health Sciences
Abstract

IntroductionChronic inflammatory diseases such as eczema (also known as atopic dermatitis) have been inconsistently linked to cardiovascular disease and stroke in both mechanistic and epidemiological studies. There is a need to review the existing epidemiological data examining the association between eczema and major cardiovascular outcomes, including angina, myocardial infarction, coronary revascularisation, heart failure, cardiac arrhythmias, stroke and cardiovascular death, in order to improve our understanding of the comorbidities of eczema.Methods and analysisWe will systematically review population-based studies, including cohort, case-control and cross-sectional studies, reporting on the association between eczema and cardiovascular outcomes. We will search Medline, Embase and Global Health, from their date of inception to April 2017, using a comprehensive search strategy formulated with the help of a librarian. Two reviewers will independently screen titles and abstracts in duplicate, followed by independent data extraction and quality assessment. We will group studies by the cardiovascular outcome under study and synthesise them narratively. If sufficient numbers of homogeneous studies are returned, we will perform meta-analyses to obtain pooled effect estimates. Preferred Reporting Items for Systematic Review and Meta-Analysis will be used to inform the reporting of this study.Trial registration numberCRD42017060359.

Published
2017

24. Development and Validation of an Algorithm to Accurately Identify Atopic Eczema Patients in Primary Care Electronic Health Records from the UK

Author

Abuabara, Katrina, Magyari, Alexa M, Hoffstad, Ole, Jabbar-Lopez, Zarif K, Smeeth, Liam, Williams, Hywel C, Gelfand, Joel M, Margolis, David J, and Langan, Sinead M

Subjects
Health Services, Clinical Research, 4.2 Evaluation of markers and technologies, Detection, screening and diagnosis, Good Health and Well Being, Adolescent, Adult, Algorithms, Child, Databases, Factual, Dermatitis, Atopic, Electronic Health Records, Female, Follow-Up Studies, Humans, Male, Primary Health Care, Surveys and Questionnaires, Time Factors, United Kingdom, Young Adult, Clinical Sciences, Oncology and Carcinogenesis, Dermatology & Venereal Diseases
Abstract

Electronic health records hold great promise for clinical and epidemiologic research. Undertaking atopic eczema (AE) research using such data is challenging because of its episodic and heterogeneous nature. We sought to develop and validate a diagnostic algorithm that identifies AE cases based on codes used for electronic records used in the UK Health Improvement Network. We found that at least one of five diagnosis codes plus two treatment codes for any skin-directed therapy were likely to accurately identify patients with AE. To validate this algorithm, a questionnaire was sent to the physicians of 200 randomly selected children and adults. The primary outcome, positive predictive value for a physician-confirmed diagnosis of AE, was 86% (95% confidence interval = 80-91). Additional criteria increased the PPV up to 95% but would miss up to 89% of individuals with physician-confirmed AE. The first and last entered diagnosis codes for individuals showed good agreement with the physician-confirmed age at onset and last disease activity; the mean difference was 0.8 years (95% confidence interval = -0.3 to 1.9) and -1.3 years (95% confidence interval = -2.5 to -0.1), respectively. A combination of diagnostic and prescription codes can be used to reliably estimate the diagnosis and duration of AE from The Health Improvement Network primary care electronic health records in the UK.

Published
2017

25. The Long-Term Course of Atopic Dermatitis

Author

Abuabara, Katrina, Margolis, David J, and Langan, Sinéad M

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Acquired Cognitive Impairment, Dementia, Eczema / Atopic Dermatitis, Brain Disorders, Skin, Dermatitis, Atopic, Humans, Incidence, Prevalence, Recurrence, Remission Induction, Secondary Prevention, Symptom Flare Up, Time Factors, Atopic dermatitis, Eczema, Atopic eczema, Epidemiology, Natural history, Clinical course, Dermatology & Venereal Diseases, Clinical sciences
Abstract

Atopic dermatitis (AD) is a chronic, relapsing condition, meaning that the intensity of symptoms usually fluctuates over time. Changes in skin physiology may be evident from birth, suggesting that AD may be a lifelong condition marked by intermittent symptoms/disease activity. Methodological considerations for studying the long-term course of AD are reviewed in detail. Improved measurement of the frequency and duration of active disease periods can help to elucidate more about the clinical course AD and the role of treatment in long-term outcomes.

Published
2017

27. Utility of transepidermal water loss‐stratum corneum hydration ratio in atopic dermatitis.

Author

Sreekantaswamy, Shreya, Meyer, Jason, Grinich, Erin, Leshem, Yael, Simpson, Eric, and Abuabara, Katrina

Subjects
ATOPIC dermatitis, HYDRATION, WATER vapor, WATER utilities, WATER vapor transport
Abstract

This article discusses the utility of the transepidermal water loss (TEWL) to stratum corneum hydration (SCH) ratio in atopic dermatitis (AD). The study compares the performance of the TEWL:SCH ratio to TEWL and SCH alone in differentiating nonlesional skin in AD from healthy controls, differentiating disease severity in nonlesional AD skin, and identifying changes after emollient treatment in nonlesional AD skin. The results show that TEWL alone is the best indicator for distinguishing AD from controls and disease severity, while the TEWL:SCH ratio may be more sensitive to changes after emollient use. The study suggests that the TEWL:SCH ratio could be a useful measure in future dermatology trials. [Extracted from the article]

Published
2024
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28. Infections in children with eczema in UK general practice- a cohort study

Author

Langan, Sinéad M, Abuabara, Katrina, Henrickson, Sarah E, Hoffstad, Ole, and Margolis, David J

Abstract

BackgroundCase reports and cross-sectional studies suggest increased risks of cutaneous and non-cutaneous infections in eczema; this relationship needs to be assessed in large population-based studies with diagnostic confirmation. The objective was to examine associations between eczema and common childhood infections.MethodsIndividuals registered prior to age 18 in the Health Improvement Network, a UK general practice database, from 2003 to 2013 were included in this cohort study. We determined the association between eczema and selected infectious outcomes, including cutaneous (dermatophyte, herpes simplex virus, impetigo, molluscum contagiosum and warts), and non-cutaneous infections (otitis media, streptococcal throat infections, and pneumonia).ResultsEczema was diagnosed in 14.4% (95% confidence interval 14.4, 14.4), and the average age of eczema diagnosis was 7.94 years (7.91, 7.98). All of the infectious illnesses were more prevalent in those with eczema compared to those without, with adjusted odds ratios (95% confidence intervals) as follows: dermatophyte 2.54 (2.47-2.61), herpes simplex virus, 2.08 (2.04-2.12), impetigo 2.61 (2.53-2.68), molluscum contagiosum 3.11 (3.07-3.14) and warts 1.98 (1.96-2.00). For non-cutaneous outcomes, the odds of otitis media, streptococcal throat infections and pneumonia were 2.24 (2.22-2.25), 1.75 (1.69-1.82) and 1.27 (1.23,1.31). Associations were attenuated in sensitivity analyses.ConclusionSelected infectious illnesses were more prevalent in those with eczema versus those without, with the strength of association varying from 75% increase in streptococcal throat infections to a three-fold increased prevalence for molluscum contagiosum. Findings suggest there may be generalized immune dysfunction in eczema predisposing to increased risk of various infections, which is important for clinical management

Published
2016

32. Global, regional, and national incidence of six major immune-mediated inflammatory diseases: findings from the global burden of disease study 2019

Author

Wu, D, Jin, Y, Xing, Y, Abate, M, Abbasian, M, Abbasi-Kangevari, M, Abbasi-Kangevari, Z, Abd-Allah, F, Abdelmasseh, M, Abdollahifar, M, Abdulah, D, Abedi, A, Abedi, V, Abidi, H, Aboagye, R, Abolhassani, H, Abuabara, K, Abyadeh, M, Addo, I, Adeniji, K, Adepoju, A, Adesina, M, Sakilah Adnani, Q, Afarideh, M, Aghamiri, S, Agodi, A, Agrawal, A, Aguilera Arriagada, C, Ahmad, A, Ahmad, D, Ahmad, S, Ahmadi, A, Ahmed, A, Aithala, J, Ajadi, A, Ajami, M, Akbarzadeh-Khiavi, M, Alahdab, F, Albataineh, M, Alemi, S, Saeed Al-Gheethi, A, Ali, L, Alif, S, Almazan, J, Almustanyir, S, Alqahtani, J, Alqasmi, I, Khan Altaf, I, Alvis-Guzman, N, Alvis-Zakzuk, N, Al-Worafi, Y, Aly, H, Amani, R, Amu, H, Amusa, G, Andrei, C, Ansar, A, Ansariniya, H, Anyasodor, A, Arabloo, J, Arefnezhad, R, Arulappan, J, Asghari-Jafarabadi, M, Ashraf, T, Atata, J, Athari, S, Atlaw, D, Wahbi Atout, M, Aujayeb, A, Awan, A, Ayatollahi, H, Azadnajafabad, S, Azzam, A, Badawi, A, Badiye, A, Bagherieh, S, Baig, A, Bantie, B, Barchitta, M, Bardhan, M, Barker-Collo, S, Barone-Adesi, F, Batra, K, Bayileyegn, N, Behnoush, A, Belgaumi, U, Bemanalizadeh, M, Bensenor, I, Beyene, K, Bhagavathula, A, Bhardwaj, P, Bhaskar, S, Bhat, A, Bitaraf, S, Bitra, V, Boloor, A, Bora, K, Botelho, J, Buchbinder, R, Calina, D, Cámera, L, Carvalho, A, Kai Chan, J, Chattu, V, Abebe, E, Chichagi, F, Choi, S, Chou, T, Chu, D, Coberly, K, Costa, V, Couto, R, Cruz-Martins, N, Dadras, O, Dai, X, Damiani, G, Dascalu, A, Dashti, M, Debela, S, Dellavalle, R, Demetriades, A, Demlash, A, Deng, X, Desai, H, Desai, R, Rahman Dewan, S, Dey, S, Dharmaratne, S, Diaz, D, Dibas, M, Dinis-Oliveira, R, Diress, M, Do, T, Doan, D, Dodangeh, M, Dongarwar, D, Dube, J, Dziedzic, A, Ed-Dra, A, Edinur, H, Eissazade, N, Ekholuenetale, M, Ekundayo, T, Elemam, N, Elhadi, M, Elmehrath, A, Abdou Elmeligy, O, Emamverdi, M, Emeto, T, Esayas, H, Eshetu, H, Etaee, F, Fagbamigbe, A, Faghani, S, Fakhradiyev, I, Fatehizadeh, A, Fathi, M, Feizkhah, A, Fekadu, G, Fereidouni, M, Fereshtehnejad, S, Fernandes, J, Ferrara, P, Fetensa, G, Filip, I, Fischer, F, Foroutan, B, Foroutan, M, Fukumoto, T, Ganesan, B, Belete Gemeda, B, Ghamari, S, Ghasemi, M, Gholamalizadeh, M, Gill, T, Gillum, R, Goldust, M, Golechha, M, Goleij, P, Golinelli, D, Goudarzi, H, Guan, S, Guo, Y, Gupta, B, Gupta, V, Haddadi, R, Hadi, N, Halwani, R, Haque, S, Hasan, I, Hashempour, R, Hassan, A, Hassan, T, Hassanzadeh, S, Hassen, M, Haubold, J, Hayat, K, Heidari, G, Heidari, M, Heidari-Soureshjani, R, Herteliu, C, Hessami, K, Hezam, K, Hiraike, Y, Holla, R, Hosseini, M, Huynh, H, Hwang, B, Ibitoye, S, Ilic, I, Ilic, M, Iranmehr, A, Iravanpour, F, Ismail, N, Iwagami, M, Iwu, C, Jacob, L, Jafarinia, M, Jafarzadeh, A, Jahankhani, K, Jahrami, H, Jakovljevic, M, Jamshidi, E, Jani, C, Janodia, M, Jayapal, S, Jayaram, S, Jeganathan, J, Jonas, J, Joseph, A, Joseph, N, Joshua, C, Vaishali, K, Kaambwa, B, Kabir, A, Kabir, Z, Kadashetti, V, Kaliyadan, F, Kalroozi, F, Kamal, V, Kandel, A, Kandel, H, Kanungo, S, Karami, J, Karaye, I, Karimi, H, Kasraei, H, Kazemian, S, Kebede, S, Keikavoosi-Arani, L, Keykhaei, M, Khader, Y, Khajuria, H, Khamesipour, F, Khan, E, Khan, I, Khan, M, Khatatbeh, H, Khatatbeh, M, Khateri, S, Khayat Kashani, H, Kim, M, Kisa, A, Kisa, S, Koh, H, Kolkhir, P, Korzh, O, Kotnis, A, Koul, P, Koyanagi, A, Krishan, K, Kuddus, M, Kulkarni, V, Kumar, N, Kundu, S, Kurmi, O, La Vecchia, C, Lahariya, C, Laksono, T, Lám, J, Latief, K, Lauriola, P, Lawal, B, Thu Le, T, Bich Le, T, Lee, M, Lee, S, Lee, W, Lee, Y, Lenzi, J, Levi, M, Li, W, Ligade, V, Lim, S, Liu, G, Liu, X, Llanaj, E, Lo, C, Machado, V, Maghazachi, A, Mahmoud, M, Mai, T, Majeed, A, Sanaye, P, Makram, O, Rad, E, Malhotra, K, Malik, A, Malik, I, Mallhi, T, Malta, D, Mansournia, M, Mantovani, L, Martorell, M, Masoudi, S, Masoumi, S, Mathangasinghe, Y, Mathews, E, Mathioudakis, A, Maugeri, A, Mayeli, M, Carabeo Medina, J, Meles, G, Mendes, J, Menezes, R, Mestrovic, T, Michalek, I, Micheletti Gomide Nogueira de Sá, A, Mihretie, E, Nhat Minh, L, Mirfakhraie, R, Mirrakhimov, E, Misganaw, A, Mohamadkhani, A, Mohamed, N, Mohammadi, F, Mohammadi, S, Mohammed, S, Mohan, S, Mohseni, A, Mokdad, A, Momtazmanesh, S, Monasta, L, Moni, M, Moniruzzaman, M, Moradi, Y, Morovatdar, N, Mostafavi, E, Mousavi, P, Mukoro, G, Mulita, A, Mulu, G, Murillo-Zamora, E, Musaigwa, F, Mustafa, G, Muthu, S, Nainu, F, Nangia, V, Swamy, S, Natto, Z, Navaraj, P, Nayak, B, Nazri-Panjaki, A, Negash, H, Nematollahi, M, Nguyen, D, Hien Nguyen, H, Nguyen, H, Nguyen, P, Nguyen, V, Niazi, R, Nikolouzakis, T, Nnyanzi, L, Noreen, M, Nzoputam, C, Nzoputam, O, Oancea, B, Oh, I, Okati-Aliabad, H, Okonji, O, Okwute, P, Olagunju, A, Olatubi, M, Olufadewa, I, Ordak, M, Otstavnov, N, Owolabi, M, Mahesh, P, Padubidri, J, Pak, A, Pakzad, R, Palladino, R, Pana, A, Pantazopoulos, I, Papadopoulou, P, Pardhan, S, Parthasarathi, A, Pashaei, A, Patel, J, Pathan, A, Patil, S, Paudel, U, Pawar, S, Pedersini, P, Pensato, U, Pereira, D, Pereira, J, Pereira, M, Pereira, R, Peres, M, Perianayagam, A, Perna, S, Petcu, I, Pezeshki, P, Pham, H, Philip, A, Piradov, M, Podder, I, Podder, V, Poddighe, D, Sady Prates, E, Qattea, I, Radfar, A, Raee, P, Rafiei, A, Raggi, A, Rahim, F, Rahimi, M, Rahimifard, M, Rahimi-Movaghar, V, Rahman, M, Ur Rahman, M, Rahmani, A, Rahmani, M, Rahmani, S, Rahmanian, V, Ramasubramani, P, Rancic, N, Rao, I, Rashedi, S, Rashid, A, Ravikumar, N, Rawaf, S, Mohamed Redwan, E, Rezaei, N, Rezaeian, M, Ribeiro, D, Rodrigues, M, Buendia Rodriguez, J, Roever, L, Romero-Rodríguez, E, Saad, A, Saddik, B, Sadeghian, S, Saeed, U, Safary, A, Safdarian, M, Safi, S, Saghazadeh, A, Sagoe, D, Sharif-Askari, F, Sharif-Askari, N, Sahebkar, A, Sahoo, H, Sahraian, M, Sajid, M, Sakhamuri, S, Sakshaug, J, Saleh, M, Salehi, L, Salehi, S, Farrokhi, A, Samadzadeh, S, Samargandy, S, Samieefar, N, Samy, A, Sanadgol, N, Sanjeev, R, Sawhney, M, Saya, G, Schuermans, A, Senthilkumaran, S, Sepanlou, S, Sethi, Y, Shafie, M, Shah, H, Shahid, I, Shahid, S, Shaikh, M, Sharfaei, S, Sharma, M, Shayan, M, Shehata, H, Sheikh, A, Shetty, J, Shin, J, Shirkoohi, R, Shitaye, N, Shivakumar, K, Shivarov, V, Shobeiri, P, Siabani, S, Sibhat, M, Siddig, E, Simpson, C, Sinaei, E, Singh, H, Singh, I, Singh, J, Singh, P, Singh, S, Siraj, M, Al Mamun Sohag, A, Solanki, R, Solikhah, S, Solomon, Y, Soltani-Zangbar, M, Sun, J, Szeto, M, Tabarés-Seisdedos, R, Tabatabaei, S, Tabish, M, Taheri, E, Tahvildari, A, Talaat, I, Lukenze Tamuzi, J, Tan, K, Tat, N, Oliaee, R, Tavasol, A, Temsah, M, Thangaraju, P, Tharwat, S, Tibebu, N, Vera Ticoalu, J, Tillawi, T, Tiruye, T, Tiyuri, A, Tovani-Palone, M, Tripathi, M, Tsegay, G, Tualeka, A, Ty, S, Ubah, C, Ullah, S, Umair, M, Umakanthan, S, Upadhyay, E, Vahabi, S, Vaithinathan, A, Tahbaz, S, Valizadeh, R, Varthya, S, Vasankari, T, Venketasubramanian, N, Verras, G, Villafañe, J, Vlassov, V, Vo, D, Waheed, Y, Waris, A, Welegebrial, B, Westerman, R, Wickramasinghe, D, Wickramasinghe, N, Willekens, B, Woldegeorgis, B, Woldemariam, M, Xiao, H, Yada, D, Yahya, G, Yang, L, Yazdanpanah, F, Yon, D, Yonemoto, N, You, Y, Zahir, M, Zaidi, S, Zangiabadian, M, Zare, I, Zeineddine, M, Zemedikun, D, Zeru, N, Zhang, C, Zhao, H, Zhong, C, Zielińska, M, Zoladl, M, Zumla, A, Guo, C, Tam, L, Wu, Dongze, Jin, Yingzhao, Xing, Yuhan, Abate, Melsew Dagne, Abbasian, Mohammadreza, Abbasi-Kangevari, Mohsen, Abbasi-Kangevari, Zeinab, Abd-Allah, Foad, Abdelmasseh, Michael, Abdollahifar, Mohammad-Amin, Abdulah, Deldar Morad, Abedi, Aidin, Abedi, Vida, Abidi, Hassan, Aboagye, Richard Gyan, Abolhassani, Hassan, Abuabara, Katrina, Abyadeh, Morteza, Addo, Isaac Yeboah, Adeniji, Kayode Nelson, Adepoju, Abiola Victor, Adesina, Miracle Ayomikun, Sakilah Adnani, Qorinah Estiningtyas, Afarideh, Mohsen, Aghamiri, Shahin, Agodi, Antonella, Agrawal, Anurag, Aguilera Arriagada, Constanza Elizabeth, Ahmad, Aqeel, Ahmad, Danish, Ahmad, Sajjad, Ahmad, Sohail, Ahmadi, Ali, Ahmed, Ali, Ahmed, Ayman, Aithala, Janardhana P., Ajadi, Abdullateef Abiodun, Ajami, Marjan, Akbarzadeh-Khiavi, Mostafa, Alahdab, Fares, AlBataineh, Mohammad T., Alemi, Sharifullah, Saeed Al-Gheethi, Adel Ali, Ali, Liaqat, Alif, Sheikh Mohammad, Almazan, Joseph Uy, Almustanyir, Sami, Alqahtani, Jaber S., Alqasmi, Ibrahim, Khan Altaf, Ihsan Ullah, Alvis-Guzman, Nelson, Alvis-Zakzuk, Nelson J., Al-Worafi, Yaser Mohammed, Aly, Hany, Amani, Reza, Amu, Hubert, Amusa, Ganiyu Adeniyi, Andrei, Catalina Liliana, Ansar, Adnan, Ansariniya, Hossein, Anyasodor, Anayochukwu Edward, Arabloo, Jalal, Arefnezhad, Reza, Arulappan, Judie, Asghari-Jafarabadi, Mohammad, Ashraf, Tahira, Atata, Jamila Abdulhamid, Athari, Seyyed Shamsadin, Atlaw, Daniel, Wahbi Atout, Maha Moh'd, Aujayeb, Avinash, Awan, Asma Tahir, Ayatollahi, Haleh, Azadnajafabad, Sina, Azzam, Ahmed Y., Badawi, Alaa, Badiye, Ashish D., Bagherieh, Sara, Baig, Atif Amin, Bantie, Berihun Bantie, Barchitta, Martina, Bardhan, Mainak, Barker-Collo, Suzanne Lyn, Barone-Adesi, Francesco, Batra, Kavita, Bayileyegn, Nebiyou Simegnew, Behnoush, Amir Hossein, Belgaumi, Uzma Iqbal, Bemanalizadeh, Maryam, Bensenor, Isabela M., Beyene, Kebede A., Bhagavathula, Akshaya Srikanth, Bhardwaj, Pankaj, Bhaskar, Sonu, Bhat, Ajay Nagesh, Bitaraf, Saeid, Bitra, Veera R., Boloor, Archith, Bora, Kaustubh, Botelho, João Silva, Buchbinder, Rachelle, Calina, Daniela, Cámera, Luis Alberto, Carvalho, Andre F., Kai Chan, Jeffrey Shi, Chattu, Vijay Kumar, Abebe, Endeshaw Chekol, Chichagi, Fatemeh, Choi, Sungchul, Chou, Tzu-Chieh, Chu, Dinh-Toi, Coberly, Kaleb, Costa, Vera Marisa, Couto, Rosa A. S., Cruz-Martins, Natália, Dadras, Omid, Dai, Xiaochen, Damiani, Giovanni, Dascalu, Ana Maria, Dashti, Mohsen, Debela, Sisay Abebe, Dellavalle, Robert Paul, Demetriades, Andreas K., Demlash, Alemayehu Anley, Deng, Xinlei, Desai, Hardik Dineshbhai, Desai, Rupak, Rahman Dewan, Syed Masudur, Dey, Sourav, Dharmaratne, Samath Dhamminda, Diaz, Daniel, Dibas, Mahmoud, Dinis-Oliveira, Ricardo Jorge, Diress, Mengistie, Do, Thanh Chi, Doan, Duy Khanh, Dodangeh, Masoud, Dodangeh, Milad, Dongarwar, Deepa, Dube, John, Dziedzic, Arkadiusz Marian, Ed-Dra, Abdelaziz, Edinur, Hisham Atan, Eissazade, Negin, Ekholuenetale, Michael, Ekundayo, Temitope Cyrus, Elemam, Noha Mousaad, Elhadi, Muhammed, Elmehrath, Ahmed O., Abdou Elmeligy, Omar Abdelsadek, Emamverdi, Mehdi, Emeto, Theophilus I., Esayas, Hawi Leul, Eshetu, Habitu Birhan, Etaee, Farshid, Fagbamigbe, Adeniyi Francis, Faghani, Shahriar, Fakhradiyev, Ildar Ravisovich, Fatehizadeh, Ali, Fathi, Mobina, Feizkhah, Alireza, Fekadu, Ginenus, Fereidouni, Mohammad, Fereshtehnejad, Seyed-Mohammad, Fernandes, João C., Ferrara, Pietro, Fetensa, Getahun, Filip, Irina, Fischer, Florian, Foroutan, Behzad, Foroutan, Masoud, Fukumoto, Takeshi, Ganesan, Balasankar, Belete Gemeda, Belete Negese, Ghamari, Seyyed-Hadi, Ghasemi, MohammadReza, Gholamalizadeh, Maryam, Gill, Tiffany K., Gillum, Richard F., Goldust, Mohamad, Golechha, Mahaveer, Goleij, Pouya, Golinelli, Davide, Goudarzi, Houman, Guan, Shi-Yang, Guo, Yang, Gupta, Bhawna, Gupta, Veer Bala, Gupta, Vivek Kumar, Haddadi, Rasool, Hadi, Najah R., Halwani, Rabih, Haque, Shafiul, Hasan, Ikramul, Hashempour, Reza, Hassan, Amr, Hassan, Treska S., Hassanzadeh, Sara, Hassen, Mohammed Bheser, Haubold, Johannes, Hayat, Khezar, Heidari, Golnaz, Heidari, Mohammad, Heidari-Soureshjani, Reza, Herteliu, Claudiu, Hessami, Kamran, Hezam, Kamal, Hiraike, Yuta, Holla, Ramesh, Hosseini, Mohammad-Salar, Huynh, Hong-Han, Hwang, Bing-Fang, Ibitoye, Segun Emmanuel, Ilic, Irena M., Ilic, Milena D., Iranmehr, Arad, Iravanpour, Farideh, Ismail, Nahlah Elkudssiah, Iwagami, Masao, Iwu, Chidozie C. D., Jacob, Louis, Jafarinia, Morteza, Jafarzadeh, Abdollah, Jahankhani, Kasra, Jahrami, Haitham, Jakovljevic, Mihajlo, Jamshidi, Elham, Jani, Chinmay T., Janodia, Manthan Dilipkumar, Jayapal, Sathish Kumar, Jayaram, Shubha, Jeganathan, Jayakumar, Jonas, Jost B., Joseph, Abel, Joseph, Nitin, Joshua, Charity Ehimwenma, Vaishali, K., Kaambwa, Billingsley, Kabir, Ali, Kabir, Zubair, Kadashetti, Vidya, Kaliyadan, Feroze, Kalroozi, Fatemeh, Kamal, Vineet Kumar, Kandel, Amit, Kandel, Himal, Kanungo, Srikanta, Karami, Jafar, Karaye, Ibraheem M., Karimi, Hanie, Kasraei, Hengameh, Kazemian, Sina, Kebede, Sewnet Adem, Keikavoosi-Arani, Leila, Keykhaei, Mohammad, Khader, Yousef Saleh, Khajuria, Himanshu, Khamesipour, Faham, Khan, Ejaz Ahmad, Khan, Imteyaz A., Khan, Maseer, Khan, Md Jobair, Khan, Moien A. B., Khan, Muhammad Arslan, Khatatbeh, Haitham, Khatatbeh, Moawiah Mohammad, Khateri, Sorour, Khayat Kashani, Hamid Reza, Kim, Min Seo, Kisa, Adnan, Kisa, Sezer, Koh, Hyun Yong, Kolkhir, Pavel, Korzh, Oleksii, Kotnis, Ashwin Laxmikant, Koul, Parvaiz A., Koyanagi, Ai, Krishan, Kewal, Kuddus, Mohammed, Kulkarni, Vishnutheertha Vishnutheertha, Kumar, Narinder, Kundu, Satyajit, Kurmi, Om P., La Vecchia, Carlo, Lahariya, Chandrakant, Laksono, Tri, Lám, Judit, Latief, Kamaluddin, Lauriola, Paolo, Lawal, Basira Kankia, Thu Le, Thao Thi, Bich Le, Trang Thi, Lee, Munjae, Lee, Seung Won, Lee, Wei-Chen, Lee, Yo Han, Lenzi, Jacopo, Levi, Miriam, Li, Wei, Ligade, Virendra S., Lim, Stephen S., Liu, Gang, Liu, Xuefeng, Llanaj, Erand, Lo, Chun-Han, Machado, Vanessa Sintra, Maghazachi, Azzam A., Mahmoud, Mansour Adam, Mai, Tuan A., Majeed, Azeem, Sanaye, Pantea Majma, Makram, Omar Mohamed, Rad, Elaheh Malakan, Malhotra, Kashish, Malik, Ahmad Azam, Malik, Iram, Mallhi, Tauqeer Hussain, Malta, Deborah Carvalho, Mansournia, Mohammad Ali, Mantovani, Lorenzo Giovanni, Martorell, Miquel, Masoudi, Sahar, Masoumi, Seyedeh Zahra, Mathangasinghe, Yasith, Mathews, Elezebeth, Mathioudakis, Alexander G., Maugeri, Andrea, Mayeli, Mahsa, Carabeo Medina, John Robert, Meles, Gebrekiros Gebremichael, Mendes, José João, Menezes, Ritesh G., Mestrovic, Tomislav, Michalek, Irmina Maria, Micheletti Gomide Nogueira de Sá, Ana Carolina, Mihretie, Ephrem Tesfaye, Nhat Minh, Le Huu, Mirfakhraie, Reza, Mirrakhimov, Erkin M., Misganaw, Awoke, Mohamadkhani, Ashraf, Mohamed, Nouh Saad, Mohammadi, Faezeh, Mohammadi, Soheil, Mohammed, Salahuddin, Mohammed, Shafiu, Mohan, Syam, Mohseni, Anita, Mokdad, Ali H., Momtazmanesh, Sara, Monasta, Lorenzo, Moni, Mohammad Ali, Moniruzzaman, Md, Moradi, Yousef, Morovatdar, Negar, Mostafavi, Ebrahim, Mousavi, Parsa, Mukoro, George Duke, Mulita, Admir, Mulu, Getaneh Baye, Murillo-Zamora, Efrén, Musaigwa, Fungai, Mustafa, Ghulam, Muthu, Sathish, Nainu, Firzan, Nangia, Vinay, Swamy, Sreenivas Narasimha, Natto, Zuhair S., Navaraj, Perumalsamy, Nayak, Biswa Prakash, Nazri-Panjaki, Athare, Negash, Hadush, Nematollahi, Mohammad Hadi, Nguyen, Dang H., Hien Nguyen, Hau Thi, Nguyen, Hien Quang, Nguyen, Phat Tuan, Nguyen, Van Thanh, Niazi, Robina Khan, Nikolouzakis, Taxiarchis Konstantinos, Nnyanzi, Lawrence Achilles, Noreen, Mamoona, Nzoputam, Chimezie Igwegbe, Nzoputam, Ogochukwu Janet, Oancea, Bogdan, Oh, In-Hwan, Okati-Aliabad, Hassan, Okonji, Osaretin Christabel, Okwute, Patrick Godwin, Olagunju, Andrew T., Olatubi, Matthew Idowu, Olufadewa, Isaac Iyinoluwa, Ordak, Michal, Otstavnov, Nikita, Owolabi, Mayowa O., Mahesh, P. A., Padubidri, Jagadish Rao, Pak, Anton, Pakzad, Reza, Palladino, Raffaele, Pana, Adrian, Pantazopoulos, Ioannis, Papadopoulou, Paraskevi, Pardhan, Shahina, Parthasarathi, Ashwaghosha, Pashaei, Ava, Patel, Jay, Pathan, Aslam Ramjan, Patil, Shankargouda, Paudel, Uttam, Pawar, Shrikant, Pedersini, Paolo, Pensato, Umberto, Pereira, David M., Pereira, Jeevan, Pereira, Maria Odete, Pereira, Renato B., Peres, Mario F. P., Perianayagam, Arokiasamy, Perna, Simone, Petcu, Ionela-Roxana, Pezeshki, Parmida Sadat, Pham, Hoang Tran, Philip, Anil K., Piradov, Michael A., Podder, Indrashis, Podder, Vivek, Poddighe, Dimitri, Sady Prates, Elton Junio, Qattea, Ibrahim, Radfar, Amir, Raee, Pourya, Rafiei, Alireza, Raggi, Alberto, Rahim, Fakher, Rahimi, Mehran, Rahimifard, Mahban, Rahimi-Movaghar, Vafa, Rahman, Md Obaidur, Ur Rahman, Mohammad Hifz, Rahman, Mosiur, Rahman, Muhammad Aziz, Rahmani, Amir Masoud, Rahmani, Mohamed, Rahmani, Shayan, Rahmanian, Vahid, Ramasubramani, Premkumar, Rancic, Nemanja, Rao, Indu Ramachandra, Rashedi, Sina, Rashid, Ahmed Mustafa, Ravikumar, Nakul, Rawaf, Salman, Mohamed Redwan, Elrashdy Moustafa, Rezaei, Nazila, Rezaei, Negar, Rezaei, Nima, Rezaeian, Mohsen, Ribeiro, Daniela, Rodrigues, Mónica, Buendia Rodriguez, Jefferson Antonio, Roever, Leonardo, Romero-Rodríguez, Esperanza, Saad, Aly M. A., Saddik, Basema, Sadeghian, Saeid, Saeed, Umar, Safary, Azam, Safdarian, Mahdi, Safi, Sher Zaman, Saghazadeh, Amene, Sagoe, Dominic, Sharif-Askari, Fatemeh Saheb, Sharif-Askari, Narjes Saheb, Sahebkar, Amirhossein, Sahoo, Harihar, Sahraian, Mohammad Ali, Sajid, Mirza Rizwan, Sakhamuri, Sateesh, Sakshaug, Joseph W., Saleh, Mohamed A., Salehi, Leili, Salehi, Sana, Farrokhi, Amir Salek, Samadzadeh, Sara, Samargandy, Saad, Samieefar, Noosha, Samy, Abdallah M., Sanadgol, Nima, Sanjeev, Rama Krishna, Sawhney, Monika, Saya, Ganesh Kumar, Schuermans, Art, Senthilkumaran, Subramanian, Sepanlou, Sadaf G., Sethi, Yashendra, Shafie, Mahan, Shah, Humaira, Shahid, Izza, Shahid, Samiah, Shaikh, Masood Ali, Sharfaei, Sadaf, Sharma, Manoj, Shayan, Maryam, Shehata, Hatem Samir, Sheikh, Aziz, Shetty, Jeevan K., Shin, Jae Il, Shirkoohi, Reza, Shitaye, Nebiyu Aniley, Shivakumar, K. M., Shivarov, Velizar, Shobeiri, Parnian, Siabani, Soraya, Sibhat, Migbar Mekonnen, Siddig, Emmanuel Edwar, Simpson, Colin R., Sinaei, Ehsan, Singh, Harpreet, Singh, Inderbir, Singh, Jasvinder A., Singh, Paramdeep, Singh, Surjit, Siraj, Md Shahjahan, Al Mamun Sohag, Abdullah, Solanki, Ranjan, Solikhah, Solikhah, Solomon, Yonatan, Soltani-Zangbar, Mohammad Sadegh, Sun, Jing, Szeto, Mindy D., Tabarés-Seisdedos, Rafael, Tabatabaei, Seyyed Mohammad, Tabish, Mohammad, Taheri, Ensiyeh, Tahvildari, Azin, Talaat, Iman M., Lukenze Tamuzi, Jacques J. L., Tan, Ker-Kan, Tat, Nathan Y., Oliaee, Razieh Tavakoli, Tavasol, Arian, Temsah, Mohamad-Hani, Thangaraju, Pugazhenthan, Tharwat, Samar, Tibebu, Nigusie Selomon, Vera Ticoalu, Jansje Henny, Tillawi, Tala, Tiruye, Tenaw Yimer, Tiyuri, Amir, Tovani-Palone, Marcos Roberto, Tripathi, Manjari, Tsegay, Guesh Mebrahtom, Tualeka, Abdul Rohim, Ty, Sree Sudha, Ubah, Chukwudi S., Ullah, Saif, Ullah, Sana, Umair, Muhammad, Umakanthan, Srikanth, Upadhyay, Era, Vahabi, Seyed Mohammad, Vaithinathan, Asokan Govindaraj, Tahbaz, Sahel Valadan, Valizadeh, Rohollah, Varthya, Shoban Babu, Vasankari, Tommi Juhani, Venketasubramanian, Narayanaswamy, Verras, Georgios-Ioannis, Villafañe, Jorge Hugo, Vlassov, Vasily, Vo, Danh Cao, Waheed, Yasir, Waris, Abdul, Welegebrial, Brhane Gebrehiwot, Westerman, Ronny, Wickramasinghe, Dakshitha Praneeth, Wickramasinghe, Nuwan Darshana, Willekens, Barbara, Woldegeorgis, Beshada Zerfu, Woldemariam, Melat, Xiao, Hong, Yada, Dereje Y., Yahya, Galal, Yang, Lin, Yazdanpanah, Fereshteh, Yon, Dong Keon, Yonemoto, Naohiro, You, Yuyi, Zahir, Mazyar, Zaidi, Syed Saoud, Zangiabadian, Moein, Zare, Iman, Zeineddine, Mohammad A., Zemedikun, Dawit T., Zeru, Naod Gebrekrstos, Zhang, Chen, Zhao, Hanqing, Zhong, Chenwen, Zielińska, Magdalena, Zoladl, Mohammad, Zumla, Alimuddin, Guo, Cui, Tam, Lai-shan, Wu, D, Jin, Y, Xing, Y, Abate, M, Abbasian, M, Abbasi-Kangevari, M, Abbasi-Kangevari, Z, Abd-Allah, F, Abdelmasseh, M, Abdollahifar, M, Abdulah, D, Abedi, A, Abedi, V, Abidi, H, Aboagye, R, Abolhassani, H, Abuabara, K, Abyadeh, M, Addo, I, Adeniji, K, Adepoju, A, Adesina, M, Sakilah Adnani, Q, Afarideh, M, Aghamiri, S, Agodi, A, Agrawal, A, Aguilera Arriagada, C, Ahmad, A, Ahmad, D, Ahmad, S, Ahmadi, A, Ahmed, A, Aithala, J, Ajadi, A, Ajami, M, Akbarzadeh-Khiavi, M, Alahdab, F, Albataineh, M, Alemi, S, Saeed Al-Gheethi, A, Ali, L, Alif, S, Almazan, J, Almustanyir, S, Alqahtani, J, Alqasmi, I, Khan Altaf, I, Alvis-Guzman, N, Alvis-Zakzuk, N, Al-Worafi, Y, Aly, H, Amani, R, Amu, H, Amusa, G, Andrei, C, Ansar, A, Ansariniya, H, Anyasodor, A, Arabloo, J, Arefnezhad, R, Arulappan, J, Asghari-Jafarabadi, M, Ashraf, T, Atata, J, Athari, S, Atlaw, D, Wahbi Atout, M, Aujayeb, A, Awan, A, Ayatollahi, H, Azadnajafabad, S, Azzam, A, Badawi, A, Badiye, A, Bagherieh, S, Baig, A, Bantie, B, Barchitta, M, Bardhan, M, Barker-Collo, S, Barone-Adesi, F, Batra, K, Bayileyegn, N, Behnoush, A, Belgaumi, U, Bemanalizadeh, M, Bensenor, I, Beyene, K, Bhagavathula, A, Bhardwaj, P, Bhaskar, S, Bhat, A, Bitaraf, S, Bitra, V, Boloor, A, Bora, K, Botelho, J, Buchbinder, R, Calina, D, Cámera, L, Carvalho, A, Kai Chan, J, Chattu, V, Abebe, E, Chichagi, F, Choi, S, Chou, T, Chu, D, Coberly, K, Costa, V, Couto, R, Cruz-Martins, N, Dadras, O, Dai, X, Damiani, G, Dascalu, A, Dashti, M, Debela, S, Dellavalle, R, Demetriades, A, Demlash, A, Deng, X, Desai, H, Desai, R, Rahman Dewan, S, Dey, S, Dharmaratne, S, Diaz, D, Dibas, M, Dinis-Oliveira, R, Diress, M, Do, T, Doan, D, Dodangeh, M, Dongarwar, D, Dube, J, Dziedzic, A, Ed-Dra, A, Edinur, H, Eissazade, N, Ekholuenetale, M, Ekundayo, T, Elemam, N, Elhadi, M, Elmehrath, A, Abdou Elmeligy, O, Emamverdi, M, Emeto, T, Esayas, H, Eshetu, H, Etaee, F, Fagbamigbe, A, Faghani, S, Fakhradiyev, I, Fatehizadeh, A, Fathi, M, Feizkhah, A, Fekadu, G, Fereidouni, M, Fereshtehnejad, S, Fernandes, J, Ferrara, P, Fetensa, G, Filip, I, Fischer, F, Foroutan, B, Foroutan, M, Fukumoto, T, Ganesan, B, Belete Gemeda, B, Ghamari, S, Ghasemi, M, Gholamalizadeh, M, Gill, T, Gillum, R, Goldust, M, Golechha, M, Goleij, P, Golinelli, D, Goudarzi, H, Guan, S, Guo, Y, Gupta, B, Gupta, V, Haddadi, R, Hadi, N, Halwani, R, Haque, S, Hasan, I, Hashempour, R, Hassan, A, Hassan, T, Hassanzadeh, S, Hassen, M, Haubold, J, Hayat, K, Heidari, G, Heidari, M, Heidari-Soureshjani, R, Herteliu, C, Hessami, K, Hezam, K, Hiraike, Y, Holla, R, Hosseini, M, Huynh, H, Hwang, B, Ibitoye, S, Ilic, I, Ilic, M, Iranmehr, A, Iravanpour, F, Ismail, N, Iwagami, M, Iwu, C, Jacob, L, Jafarinia, M, Jafarzadeh, A, Jahankhani, K, Jahrami, H, Jakovljevic, M, Jamshidi, E, Jani, C, Janodia, M, Jayapal, S, Jayaram, S, Jeganathan, J, Jonas, J, Joseph, A, Joseph, N, Joshua, C, Vaishali, K, Kaambwa, B, Kabir, A, Kabir, Z, Kadashetti, V, Kaliyadan, F, Kalroozi, F, Kamal, V, Kandel, A, Kandel, H, Kanungo, S, Karami, J, Karaye, I, Karimi, H, Kasraei, H, Kazemian, S, Kebede, S, Keikavoosi-Arani, L, Keykhaei, M, Khader, Y, Khajuria, H, Khamesipour, F, Khan, E, Khan, I, Khan, M, Khatatbeh, H, Khatatbeh, M, Khateri, S, Khayat Kashani, H, Kim, M, Kisa, A, Kisa, S, Koh, H, Kolkhir, P, Korzh, O, Kotnis, A, Koul, P, Koyanagi, A, Krishan, K, Kuddus, M, Kulkarni, V, Kumar, N, Kundu, S, Kurmi, O, La Vecchia, C, Lahariya, C, Laksono, T, Lám, J, Latief, K, Lauriola, P, Lawal, B, Thu Le, T, Bich Le, T, Lee, M, Lee, S, Lee, W, Lee, Y, Lenzi, J, Levi, M, Li, W, Ligade, V, Lim, S, Liu, G, Liu, X, Llanaj, E, Lo, C, Machado, V, Maghazachi, A, Mahmoud, M, Mai, T, Majeed, A, Sanaye, P, Makram, O, Rad, E, Malhotra, K, Malik, A, Malik, I, Mallhi, T, Malta, D, Mansournia, M, Mantovani, L, Martorell, M, Masoudi, S, Masoumi, S, Mathangasinghe, Y, Mathews, E, Mathioudakis, A, Maugeri, A, Mayeli, M, Carabeo Medina, J, Meles, G, Mendes, J, Menezes, R, Mestrovic, T, Michalek, I, Micheletti Gomide Nogueira de Sá, A, Mihretie, E, Nhat Minh, L, Mirfakhraie, R, Mirrakhimov, E, Misganaw, A, Mohamadkhani, A, Mohamed, N, Mohammadi, F, Mohammadi, S, Mohammed, S, Mohan, S, Mohseni, A, Mokdad, A, Momtazmanesh, S, Monasta, L, Moni, M, Moniruzzaman, M, Moradi, Y, Morovatdar, N, Mostafavi, E, Mousavi, P, Mukoro, G, Mulita, A, Mulu, G, Murillo-Zamora, E, Musaigwa, F, Mustafa, G, Muthu, S, Nainu, F, Nangia, V, Swamy, S, Natto, Z, Navaraj, P, Nayak, B, Nazri-Panjaki, A, Negash, H, Nematollahi, M, Nguyen, D, Hien Nguyen, H, Nguyen, H, Nguyen, P, Nguyen, V, Niazi, R, Nikolouzakis, T, Nnyanzi, L, Noreen, M, Nzoputam, C, Nzoputam, O, Oancea, B, Oh, I, Okati-Aliabad, H, Okonji, O, Okwute, P, Olagunju, A, Olatubi, M, Olufadewa, I, Ordak, M, Otstavnov, N, Owolabi, M, Mahesh, P, Padubidri, J, Pak, A, Pakzad, R, Palladino, R, Pana, A, Pantazopoulos, I, Papadopoulou, P, Pardhan, S, Parthasarathi, A, Pashaei, A, Patel, J, Pathan, A, Patil, S, Paudel, U, Pawar, S, Pedersini, P, Pensato, U, Pereira, D, Pereira, J, Pereira, M, Pereira, R, Peres, M, Perianayagam, A, Perna, S, Petcu, I, Pezeshki, P, Pham, H, Philip, A, Piradov, M, Podder, I, Podder, V, Poddighe, D, Sady Prates, E, Qattea, I, Radfar, A, Raee, P, Rafiei, A, Raggi, A, Rahim, F, Rahimi, M, Rahimifard, M, Rahimi-Movaghar, V, Rahman, M, Ur Rahman, M, Rahmani, A, Rahmani, M, Rahmani, S, Rahmanian, V, Ramasubramani, P, Rancic, N, Rao, I, Rashedi, S, Rashid, A, Ravikumar, N, Rawaf, S, Mohamed Redwan, E, Rezaei, N, Rezaeian, M, Ribeiro, D, Rodrigues, M, Buendia Rodriguez, J, Roever, L, Romero-Rodríguez, E, Saad, A, Saddik, B, Sadeghian, S, Saeed, U, Safary, A, Safdarian, M, Safi, S, Saghazadeh, A, Sagoe, D, Sharif-Askari, F, Sharif-Askari, N, Sahebkar, A, Sahoo, H, Sahraian, M, Sajid, M, Sakhamuri, S, Sakshaug, J, Saleh, M, Salehi, L, Salehi, S, Farrokhi, A, Samadzadeh, S, Samargandy, S, Samieefar, N, Samy, A, Sanadgol, N, Sanjeev, R, Sawhney, M, Saya, G, Schuermans, A, Senthilkumaran, S, Sepanlou, S, Sethi, Y, Shafie, M, Shah, H, Shahid, I, Shahid, S, Shaikh, M, Sharfaei, S, Sharma, M, Shayan, M, Shehata, H, Sheikh, A, Shetty, J, Shin, J, Shirkoohi, R, Shitaye, N, Shivakumar, K, Shivarov, V, Shobeiri, P, Siabani, S, Sibhat, M, Siddig, E, Simpson, C, Sinaei, E, Singh, H, Singh, I, Singh, J, Singh, P, Singh, S, Siraj, M, Al Mamun Sohag, A, Solanki, R, Solikhah, S, Solomon, Y, Soltani-Zangbar, M, Sun, J, Szeto, M, Tabarés-Seisdedos, R, Tabatabaei, S, Tabish, M, Taheri, E, Tahvildari, A, Talaat, I, Lukenze Tamuzi, J, Tan, K, Tat, N, Oliaee, R, Tavasol, A, Temsah, M, Thangaraju, P, Tharwat, S, Tibebu, N, Vera Ticoalu, J, Tillawi, T, Tiruye, T, Tiyuri, A, Tovani-Palone, M, Tripathi, M, Tsegay, G, Tualeka, A, Ty, S, Ubah, C, Ullah, S, Umair, M, Umakanthan, S, Upadhyay, E, Vahabi, S, Vaithinathan, A, Tahbaz, S, Valizadeh, R, Varthya, S, Vasankari, T, Venketasubramanian, N, Verras, G, Villafañe, J, Vlassov, V, Vo, D, Waheed, Y, Waris, A, Welegebrial, B, Westerman, R, Wickramasinghe, D, Wickramasinghe, N, Willekens, B, Woldegeorgis, B, Woldemariam, M, Xiao, H, Yada, D, Yahya, G, Yang, L, Yazdanpanah, F, Yon, D, Yonemoto, N, You, Y, Zahir, M, Zaidi, S, Zangiabadian, M, Zare, I, Zeineddine, M, Zemedikun, D, Zeru, N, Zhang, C, Zhao, H, Zhong, C, Zielińska, M, Zoladl, M, Zumla, A, Guo, C, Tam, L, Wu, Dongze, Jin, Yingzhao, Xing, Yuhan, Abate, Melsew Dagne, Abbasian, Mohammadreza, Abbasi-Kangevari, Mohsen, Abbasi-Kangevari, Zeinab, Abd-Allah, Foad, Abdelmasseh, Michael, Abdollahifar, Mohammad-Amin, Abdulah, Deldar Morad, Abedi, Aidin, Abedi, Vida, Abidi, Hassan, Aboagye, Richard Gyan, Abolhassani, Hassan, Abuabara, Katrina, Abyadeh, Morteza, Addo, Isaac Yeboah, Adeniji, Kayode Nelson, Adepoju, Abiola Victor, Adesina, Miracle Ayomikun, Sakilah Adnani, Qorinah Estiningtyas, Afarideh, Mohsen, Aghamiri, Shahin, Agodi, Antonella, Agrawal, Anurag, Aguilera Arriagada, Constanza Elizabeth, Ahmad, Aqeel, Ahmad, Danish, Ahmad, Sajjad, Ahmad, Sohail, Ahmadi, Ali, Ahmed, Ali, Ahmed, Ayman, Aithala, Janardhana P., Ajadi, Abdullateef Abiodun, Ajami, Marjan, Akbarzadeh-Khiavi, Mostafa, Alahdab, Fares, AlBataineh, Mohammad T., Alemi, Sharifullah, Saeed Al-Gheethi, Adel Ali, Ali, Liaqat, Alif, Sheikh Mohammad, Almazan, Joseph Uy, Almustanyir, Sami, Alqahtani, Jaber S., Alqasmi, Ibrahim, Khan Altaf, Ihsan Ullah, Alvis-Guzman, Nelson, Alvis-Zakzuk, Nelson J., Al-Worafi, Yaser Mohammed, Aly, Hany, Amani, Reza, Amu, Hubert, Amusa, Ganiyu Adeniyi, Andrei, Catalina Liliana, Ansar, Adnan, Ansariniya, Hossein, Anyasodor, Anayochukwu Edward, Arabloo, Jalal, Arefnezhad, Reza, Arulappan, Judie, Asghari-Jafarabadi, Mohammad, Ashraf, Tahira, Atata, Jamila Abdulhamid, Athari, Seyyed Shamsadin, Atlaw, Daniel, Wahbi Atout, Maha Moh'd, Aujayeb, Avinash, Awan, Asma Tahir, Ayatollahi, Haleh, Azadnajafabad, Sina, Azzam, Ahmed Y., Badawi, Alaa, Badiye, Ashish D., Bagherieh, Sara, Baig, Atif Amin, Bantie, Berihun Bantie, Barchitta, Martina, Bardhan, Mainak, Barker-Collo, Suzanne Lyn, Barone-Adesi, Francesco, Batra, Kavita, Bayileyegn, Nebiyou Simegnew, Behnoush, Amir Hossein, Belgaumi, Uzma Iqbal, Bemanalizadeh, Maryam, Bensenor, Isabela M., Beyene, Kebede A., Bhagavathula, Akshaya Srikanth, Bhardwaj, Pankaj, Bhaskar, Sonu, Bhat, Ajay Nagesh, Bitaraf, Saeid, Bitra, Veera R., Boloor, Archith, Bora, Kaustubh, Botelho, João Silva, Buchbinder, Rachelle, Calina, Daniela, Cámera, Luis Alberto, Carvalho, Andre F., Kai Chan, Jeffrey Shi, Chattu, Vijay Kumar, Abebe, Endeshaw Chekol, Chichagi, Fatemeh, Choi, Sungchul, Chou, Tzu-Chieh, Chu, Dinh-Toi, Coberly, Kaleb, Costa, Vera Marisa, Couto, Rosa A. S., Cruz-Martins, Natália, Dadras, Omid, Dai, Xiaochen, Damiani, Giovanni, Dascalu, Ana Maria, Dashti, Mohsen, Debela, Sisay Abebe, Dellavalle, Robert Paul, Demetriades, Andreas K., Demlash, Alemayehu Anley, Deng, Xinlei, Desai, Hardik Dineshbhai, Desai, Rupak, Rahman Dewan, Syed Masudur, Dey, Sourav, Dharmaratne, Samath Dhamminda, Diaz, Daniel, Dibas, Mahmoud, Dinis-Oliveira, Ricardo Jorge, Diress, Mengistie, Do, Thanh Chi, Doan, Duy Khanh, Dodangeh, Masoud, Dodangeh, Milad, Dongarwar, Deepa, Dube, John, Dziedzic, Arkadiusz Marian, Ed-Dra, Abdelaziz, Edinur, Hisham Atan, Eissazade, Negin, Ekholuenetale, Michael, Ekundayo, Temitope Cyrus, Elemam, Noha Mousaad, Elhadi, Muhammed, Elmehrath, Ahmed O., Abdou Elmeligy, Omar Abdelsadek, Emamverdi, Mehdi, Emeto, Theophilus I., Esayas, Hawi Leul, Eshetu, Habitu Birhan, Etaee, Farshid, Fagbamigbe, Adeniyi Francis, Faghani, Shahriar, Fakhradiyev, Ildar Ravisovich, Fatehizadeh, Ali, Fathi, Mobina, Feizkhah, Alireza, Fekadu, Ginenus, Fereidouni, Mohammad, Fereshtehnejad, Seyed-Mohammad, Fernandes, João C., Ferrara, Pietro, Fetensa, Getahun, Filip, Irina, Fischer, Florian, Foroutan, Behzad, Foroutan, Masoud, Fukumoto, Takeshi, Ganesan, Balasankar, Belete Gemeda, Belete Negese, Ghamari, Seyyed-Hadi, Ghasemi, MohammadReza, Gholamalizadeh, Maryam, Gill, Tiffany K., Gillum, Richard F., Goldust, Mohamad, Golechha, Mahaveer, Goleij, Pouya, Golinelli, Davide, Goudarzi, Houman, Guan, Shi-Yang, Guo, Yang, Gupta, Bhawna, Gupta, Veer Bala, Gupta, Vivek Kumar, Haddadi, Rasool, Hadi, Najah R., Halwani, Rabih, Haque, Shafiul, Hasan, Ikramul, Hashempour, Reza, Hassan, Amr, Hassan, Treska S., Hassanzadeh, Sara, Hassen, Mohammed Bheser, Haubold, Johannes, Hayat, Khezar, Heidari, Golnaz, Heidari, Mohammad, Heidari-Soureshjani, Reza, Herteliu, Claudiu, Hessami, Kamran, Hezam, Kamal, Hiraike, Yuta, Holla, Ramesh, Hosseini, Mohammad-Salar, Huynh, Hong-Han, Hwang, Bing-Fang, Ibitoye, Segun Emmanuel, Ilic, Irena M., Ilic, Milena D., Iranmehr, Arad, Iravanpour, Farideh, Ismail, Nahlah Elkudssiah, Iwagami, Masao, Iwu, Chidozie C. D., Jacob, Louis, Jafarinia, Morteza, Jafarzadeh, Abdollah, Jahankhani, Kasra, Jahrami, Haitham, Jakovljevic, Mihajlo, Jamshidi, Elham, Jani, Chinmay T., Janodia, Manthan Dilipkumar, Jayapal, Sathish Kumar, Jayaram, Shubha, Jeganathan, Jayakumar, Jonas, Jost B., Joseph, Abel, Joseph, Nitin, Joshua, Charity Ehimwenma, Vaishali, K., Kaambwa, Billingsley, Kabir, Ali, Kabir, Zubair, Kadashetti, Vidya, Kaliyadan, Feroze, Kalroozi, Fatemeh, Kamal, Vineet Kumar, Kandel, Amit, Kandel, Himal, Kanungo, Srikanta, Karami, Jafar, Karaye, Ibraheem M., Karimi, Hanie, Kasraei, Hengameh, Kazemian, Sina, Kebede, Sewnet Adem, Keikavoosi-Arani, Leila, Keykhaei, Mohammad, Khader, Yousef Saleh, Khajuria, Himanshu, Khamesipour, Faham, Khan, Ejaz Ahmad, Khan, Imteyaz A., Khan, Maseer, Khan, Md Jobair, Khan, Moien A. B., Khan, Muhammad Arslan, Khatatbeh, Haitham, Khatatbeh, Moawiah Mohammad, Khateri, Sorour, Khayat Kashani, Hamid Reza, Kim, Min Seo, Kisa, Adnan, Kisa, Sezer, Koh, Hyun Yong, Kolkhir, Pavel, Korzh, Oleksii, Kotnis, Ashwin Laxmikant, Koul, Parvaiz A., Koyanagi, Ai, Krishan, Kewal, Kuddus, Mohammed, Kulkarni, Vishnutheertha Vishnutheertha, Kumar, Narinder, Kundu, Satyajit, Kurmi, Om P., La Vecchia, Carlo, Lahariya, Chandrakant, Laksono, Tri, Lám, Judit, Latief, Kamaluddin, Lauriola, Paolo, Lawal, Basira Kankia, Thu Le, Thao Thi, Bich Le, Trang Thi, Lee, Munjae, Lee, Seung Won, Lee, Wei-Chen, Lee, Yo Han, Lenzi, Jacopo, Levi, Miriam, Li, Wei, Ligade, Virendra S., Lim, Stephen S., Liu, Gang, Liu, Xuefeng, Llanaj, Erand, Lo, Chun-Han, Machado, Vanessa Sintra, Maghazachi, Azzam A., Mahmoud, Mansour Adam, Mai, Tuan A., Majeed, Azeem, Sanaye, Pantea Majma, Makram, Omar Mohamed, Rad, Elaheh Malakan, Malhotra, Kashish, Malik, Ahmad Azam, Malik, Iram, Mallhi, Tauqeer Hussain, Malta, Deborah Carvalho, Mansournia, Mohammad Ali, Mantovani, Lorenzo Giovanni, Martorell, Miquel, Masoudi, Sahar, Masoumi, Seyedeh Zahra, Mathangasinghe, Yasith, Mathews, Elezebeth, Mathioudakis, Alexander G., Maugeri, Andrea, Mayeli, Mahsa, Carabeo Medina, John Robert, Meles, Gebrekiros Gebremichael, Mendes, José João, Menezes, Ritesh G., Mestrovic, Tomislav, Michalek, Irmina Maria, Micheletti Gomide Nogueira de Sá, Ana Carolina, Mihretie, Ephrem Tesfaye, Nhat Minh, Le Huu, Mirfakhraie, Reza, Mirrakhimov, Erkin M., Misganaw, Awoke, Mohamadkhani, Ashraf, Mohamed, Nouh Saad, Mohammadi, Faezeh, Mohammadi, Soheil, Mohammed, Salahuddin, Mohammed, Shafiu, Mohan, Syam, Mohseni, Anita, Mokdad, Ali H., Momtazmanesh, Sara, Monasta, Lorenzo, Moni, Mohammad Ali, Moniruzzaman, Md, Moradi, Yousef, Morovatdar, Negar, Mostafavi, Ebrahim, Mousavi, Parsa, Mukoro, George Duke, Mulita, Admir, Mulu, Getaneh Baye, Murillo-Zamora, Efrén, Musaigwa, Fungai, Mustafa, Ghulam, Muthu, Sathish, Nainu, Firzan, Nangia, Vinay, Swamy, Sreenivas Narasimha, Natto, Zuhair S., Navaraj, Perumalsamy, Nayak, Biswa Prakash, Nazri-Panjaki, Athare, Negash, Hadush, Nematollahi, Mohammad Hadi, Nguyen, Dang H., Hien Nguyen, Hau Thi, Nguyen, Hien Quang, Nguyen, Phat Tuan, Nguyen, Van Thanh, Niazi, Robina Khan, Nikolouzakis, Taxiarchis Konstantinos, Nnyanzi, Lawrence Achilles, Noreen, Mamoona, Nzoputam, Chimezie Igwegbe, Nzoputam, Ogochukwu Janet, Oancea, Bogdan, Oh, In-Hwan, Okati-Aliabad, Hassan, Okonji, Osaretin Christabel, Okwute, Patrick Godwin, Olagunju, Andrew T., Olatubi, Matthew Idowu, Olufadewa, Isaac Iyinoluwa, Ordak, Michal, Otstavnov, Nikita, Owolabi, Mayowa O., Mahesh, P. A., Padubidri, Jagadish Rao, Pak, Anton, Pakzad, Reza, Palladino, Raffaele, Pana, Adrian, Pantazopoulos, Ioannis, Papadopoulou, Paraskevi, Pardhan, Shahina, Parthasarathi, Ashwaghosha, Pashaei, Ava, Patel, Jay, Pathan, Aslam Ramjan, Patil, Shankargouda, Paudel, Uttam, Pawar, Shrikant, Pedersini, Paolo, Pensato, Umberto, Pereira, David M., Pereira, Jeevan, Pereira, Maria Odete, Pereira, Renato B., Peres, Mario F. P., Perianayagam, Arokiasamy, Perna, Simone, Petcu, Ionela-Roxana, Pezeshki, Parmida Sadat, Pham, Hoang Tran, Philip, Anil K., Piradov, Michael A., Podder, Indrashis, Podder, Vivek, Poddighe, Dimitri, Sady Prates, Elton Junio, Qattea, Ibrahim, Radfar, Amir, Raee, Pourya, Rafiei, Alireza, Raggi, Alberto, Rahim, Fakher, Rahimi, Mehran, Rahimifard, Mahban, Rahimi-Movaghar, Vafa, Rahman, Md Obaidur, Ur Rahman, Mohammad Hifz, Rahman, Mosiur, Rahman, Muhammad Aziz, Rahmani, Amir Masoud, Rahmani, Mohamed, Rahmani, Shayan, Rahmanian, Vahid, Ramasubramani, Premkumar, Rancic, Nemanja, Rao, Indu Ramachandra, Rashedi, Sina, Rashid, Ahmed Mustafa, Ravikumar, Nakul, Rawaf, Salman, Mohamed Redwan, Elrashdy Moustafa, Rezaei, Nazila, Rezaei, Negar, Rezaei, Nima, Rezaeian, Mohsen, Ribeiro, Daniela, Rodrigues, Mónica, Buendia Rodriguez, Jefferson Antonio, Roever, Leonardo, Romero-Rodríguez, Esperanza, Saad, Aly M. A., Saddik, Basema, Sadeghian, Saeid, Saeed, Umar, Safary, Azam, Safdarian, Mahdi, Safi, Sher Zaman, Saghazadeh, Amene, Sagoe, Dominic, Sharif-Askari, Fatemeh Saheb, Sharif-Askari, Narjes Saheb, Sahebkar, Amirhossein, Sahoo, Harihar, Sahraian, Mohammad Ali, Sajid, Mirza Rizwan, Sakhamuri, Sateesh, Sakshaug, Joseph W., Saleh, Mohamed A., Salehi, Leili, Salehi, Sana, Farrokhi, Amir Salek, Samadzadeh, Sara, Samargandy, Saad, Samieefar, Noosha, Samy, Abdallah M., Sanadgol, Nima, Sanjeev, Rama Krishna, Sawhney, Monika, Saya, Ganesh Kumar, Schuermans, Art, Senthilkumaran, Subramanian, Sepanlou, Sadaf G., Sethi, Yashendra, Shafie, Mahan, Shah, Humaira, Shahid, Izza, Shahid, Samiah, Shaikh, Masood Ali, Sharfaei, Sadaf, Sharma, Manoj, Shayan, Maryam, Shehata, Hatem Samir, Sheikh, Aziz, Shetty, Jeevan K., Shin, Jae Il, Shirkoohi, Reza, Shitaye, Nebiyu Aniley, Shivakumar, K. M., Shivarov, Velizar, Shobeiri, Parnian, Siabani, Soraya, Sibhat, Migbar Mekonnen, Siddig, Emmanuel Edwar, Simpson, Colin R., Sinaei, Ehsan, Singh, Harpreet, Singh, Inderbir, Singh, Jasvinder A., Singh, Paramdeep, Singh, Surjit, Siraj, Md Shahjahan, Al Mamun Sohag, Abdullah, Solanki, Ranjan, Solikhah, Solikhah, Solomon, Yonatan, Soltani-Zangbar, Mohammad Sadegh, Sun, Jing, Szeto, Mindy D., Tabarés-Seisdedos, Rafael, Tabatabaei, Seyyed Mohammad, Tabish, Mohammad, Taheri, Ensiyeh, Tahvildari, Azin, Talaat, Iman M., Lukenze Tamuzi, Jacques J. L., Tan, Ker-Kan, Tat, Nathan Y., Oliaee, Razieh Tavakoli, Tavasol, Arian, Temsah, Mohamad-Hani, Thangaraju, Pugazhenthan, Tharwat, Samar, Tibebu, Nigusie Selomon, Vera Ticoalu, Jansje Henny, Tillawi, Tala, Tiruye, Tenaw Yimer, Tiyuri, Amir, Tovani-Palone, Marcos Roberto, Tripathi, Manjari, Tsegay, Guesh Mebrahtom, Tualeka, Abdul Rohim, Ty, Sree Sudha, Ubah, Chukwudi S., Ullah, Saif, Ullah, Sana, Umair, Muhammad, Umakanthan, Srikanth, Upadhyay, Era, Vahabi, Seyed Mohammad, Vaithinathan, Asokan Govindaraj, Tahbaz, Sahel Valadan, Valizadeh, Rohollah, Varthya, Shoban Babu, Vasankari, Tommi Juhani, Venketasubramanian, Narayanaswamy, Verras, Georgios-Ioannis, Villafañe, Jorge Hugo, Vlassov, Vasily, Vo, Danh Cao, Waheed, Yasir, Waris, Abdul, Welegebrial, Brhane Gebrehiwot, Westerman, Ronny, Wickramasinghe, Dakshitha Praneeth, Wickramasinghe, Nuwan Darshana, Willekens, Barbara, Woldegeorgis, Beshada Zerfu, Woldemariam, Melat, Xiao, Hong, Yada, Dereje Y., Yahya, Galal, Yang, Lin, Yazdanpanah, Fereshteh, Yon, Dong Keon, Yonemoto, Naohiro, You, Yuyi, Zahir, Mazyar, Zaidi, Syed Saoud, Zangiabadian, Moein, Zare, Iman, Zeineddine, Mohammad A., Zemedikun, Dawit T., Zeru, Naod Gebrekrstos, Zhang, Chen, Zhao, Hanqing, Zhong, Chenwen, Zielińska, Magdalena, Zoladl, Mohammad, Zumla, Alimuddin, Guo, Cui, and Tam, Lai-shan

Abstract

Background: The causes for immune-mediated inflammatory diseases (IMIDs) are diverse and the incidence trends of IMIDs from specific causes are rarely studied. The study aims to investigate the pattern and trend of IMIDs from 1990 to 2019. Methods: We collected detailed information on six major causes of IMIDs, including asthma, inflammatory bowel disease, multiple sclerosis, rheumatoid arthritis, psoriasis, and atopic dermatitis, between 1990 and 2019, derived from the Global Burden of Disease study in 2019. The average annual percent change (AAPC) in number of incidents and age standardized incidence rate (ASR) on IMIDs, by sex, age, region, and causes, were calculated to quantify the temporal trends. Findings: In 2019, rheumatoid arthritis, atopic dermatitis, asthma, multiple sclerosis, psoriasis, inflammatory bowel disease accounted 1.59%, 36.17%, 54.71%, 0.09%, 6.84%, 0.60% of overall new IMIDs cases, respectively. The ASR of IMIDs showed substantial regional and global variation with the highest in High SDI region, High-income North America, and United States of America. Throughout human lifespan, the age distribution of incident cases from six IMIDs was quite different. Globally, incident cases of IMIDs increased with an AAPC of 0.68 and the ASR decreased with an AAPC of −0.34 from 1990 to 2019. The incident cases increased across six IMIDs, the ASR of rheumatoid arthritis increased (0.21, 95% CI 0.18, 0.25), while the ASR of asthma (AAPC = −0.41), inflammatory bowel disease (AAPC = −0.72), multiple sclerosis (AAPC = −0.26), psoriasis (AAPC = −0.77), and atopic dermatitis (AAPC = −0.15) decreased. The ASR of overall and six individual IMID increased with SDI at regional and global level. Countries with higher ASR in 1990 experienced a more rapid decrease in ASR. Interpretation: The incidence patterns of IMIDs varied considerably across the world. Innovative prevention and integrative management strategy are urgently needed to mitigate the increasing ASR of rh

Published
2023

33. The association between atopic eczema and lymphopenia:Results from a UK cohort study with replication in US survey data

Author

Hollestein, Loes M., Ye, Morgan Ya Fang, Ang, Ky Leigh, Forbes, Harriet, Mansfield, Kathryn E., Abuabara, Katrina, Smeeth, Liam, Langan, Sinéad M., Hollestein, Loes M., Ye, Morgan Ya Fang, Ang, Ky Leigh, Forbes, Harriet, Mansfield, Kathryn E., Abuabara, Katrina, Smeeth, Liam, and Langan, Sinéad M.

Abstract

Background: Lymphocyte skin homing in atopic eczema (AE) may induce lymphopenia. Objective: To determine if AE is associated with lymphopenia. Methods: We used UK primary care electronic health records (Clinical Practice Research Datalink GOLD) for a matched cohort study in adults (18 years+) (1997–2015) with at least one recorded lymphocyte count. We matched people with AE to up to five people without. We used multivariable logistic regression to estimate the association between AE and lymphopenia (two low lymphocyte counts within 3 months) and linear mixed effects regression to estimate the association with absolute lymphocyte counts using all available counts. Cox proportional hazard models were used to investigate the effect of lymphopenia on common infections. We replicated the study using US survey data (National Health and Nutrition Examination Survey [NHANES]). Results: Among 71,731 adults with AE and 126,349 adults without AE, we found an adjusted odds ratio (OR) for lymphopenia of 1.16 (95% CI: 1.09–1.23); the strength of association increased with increasing eczema severity. When comparing all recorded lymphocyte counts from adults with AE (n = 1,497,306) to those of people without AE (n = 4,035,870) we saw a lower mean lymphocyte (adjusted mean difference −0.047 × 109/L [95% CI: −0.051 to −0.043]) in those with AE. The difference was larger for men, with increasing age, and with increasing AE severity and was present among people with AE not treated with immunosuppressive drugs. In NHANES (n = 22,624), the adjusted OR for lymphopenia in adults with AE was 1.30 (95% CI: 0.80–2.11), and the adjusted mean lymphocyte count difference was −0.03 × 109/L (95% CI: −0.07 to 0.02). Despite having a lower lymphocyte count, adjusting for time with lymphopenia, did not alter risk estimates of infections. Conclusion: Atopic eczema, including increasing AE severity, is associated with a decreased lymphocyte count, regardless of immunosuppressiv

Published
2023

34. Fracture incidence in children after developing atopic dermatitis : A Korean nationwide birth cohort study

Author

Lee, Seung Won, Shin, Youn Ho, Shin, Jae Il, Kang, So Min, Abuabara, Katrina, Hwang, Jimin, Shin, Jung U., Noh, Hyungrye, Kim, Sunyeup, Heo, Chan Yeong, Koyanagi, Ai, Jacob, Louis, Smith, Lee, Ludvigsson, Jonas F., Turner, Stephen, Shin, Ju-Young, Jeong, Han Eol, Kim, Jung-Hyun, Rhee, Sang Youl, Suh, Dong In, Yon, Dong Keon, Cho, Seong Ho, Lee, Seung Won, Shin, Youn Ho, Shin, Jae Il, Kang, So Min, Abuabara, Katrina, Hwang, Jimin, Shin, Jung U., Noh, Hyungrye, Kim, Sunyeup, Heo, Chan Yeong, Koyanagi, Ai, Jacob, Louis, Smith, Lee, Ludvigsson, Jonas F., Turner, Stephen, Shin, Ju-Young, Jeong, Han Eol, Kim, Jung-Hyun, Rhee, Sang Youl, Suh, Dong In, Yon, Dong Keon, and Cho, Seong Ho

Abstract

Funding agency:National Research Foundation of Korea NRF2021R1I1A2059735

Published
2023
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36. Association of Atopic Dermatitis and Mental Health Outcomes Across Childhood: A Longitudinal Cohort Study

Author

Kern, Chloe, Wan, Joy, LeWinn, Kaja Z, Ramirez, Faustine D, Lee, Yong, McCulloch, Charles E, Langan, Sinéad M, and Abuabara, Katrina

Subjects
Pediatric, Mental Health, Depression, Clinical Research, 2.3 Psychological, Prevention, Behavioral and Social Science, Clinical Sciences, Oncology and Carcinogenesis, social and economic factors, Brain Disorders
Abstract

Importance: Research has highlighted associations between atopic dermatitis (AD) and mental health conditions in adults. However, literature on the development of mental health comorbidities in children is limited despite the large burden of pediatric AD worldwide. Objective: To examine the association between AD and internalizing behaviors and symptoms of depression at multiple points across childhood and adolescence and to explore potential mediating factors, including asthma/rhinitis, sleep, and inflammation. Design, Setting, and Participants: This longitudinal, population-based birth cohort study included children followed up from birth for a mean (SD) duration of 10.0 (2.9) years from the UK Avon Longitudinal Study of Parents and Children. Data were collected from September 6, 1990, to December 31, 2009. Data were analyzed from August 30, 2019, to July 30, 2020. Exposures: Annual period prevalence of AD assessed at 11 points from 6 months to 18 years of age, measured by standardized questions about flexural dermatitis. Main Outcomes and Measures: Symptoms of depression, measured using child-reported responses to the Short Moods and Feelings Questionnaire at 5 points from 10 to 18 years of age and internalizing behaviors, measured by maternal report of the Emotional Symptoms subscale of the Strength and Difficulties Questionnaire at 7 points from 4 to 16 years of age. Results: Among the 11 181 children included in the analysis (5721 male [51.2%]), the period prevalence of symptoms of depression ranged from 6.0% to 21.6%; for internalizing behaviors, from 10.4% to 16.0%. Although mild to moderate AD was not associated with symptoms of depression, it was associated with internalizing behaviors as early as 4 years of age (mean increased odds of 29%-84% across childhood in adjusted models). Severe AD was associated with symptoms of depression (adjusted odds ratio, 2.38; 95% CI, 1.21-4.72) and internalizing symptoms (adjusted odds ratio, 1.90; 95% CI, 1.14-3.16). Sleep quality mediated some of this association, but it was not explained by differences in sleep duration, asthma/rhinitis, or levels of inflammatory markers (interleukin 6 and C-reactive protein). Conclusions and Relevance: Within this population-based birth cohort study in the UK, severe AD was associated with symptoms of depression and internalizing behaviors throughout childhood and adolescence. Risk of internalizing symptoms was increased even for children with mild AD beginning early in childhood, highlighting the importance of behavioral and mental health awareness in this population.

Published
2021

37. Association of Wildfire Air Pollution and Health Care Use for Atopic Dermatitis and Itch

Author

Fadadu, Raj P, Grimes, Barbara, Jewell, Nicholas P, Vargo, Jason, Young, Albert T, Abuabara, Katrina, Balmes, John R, and Wei, Maria L

Abstract

IMPORTANCE: Air pollution is a worldwide public health issue that has been exacerbated by recent wildfires, but the relationship between wildfire-associated air pollution and inflammatory skin diseases is unknown. OBJECTIVE: To assess the associations between wildfire-associated air pollution and clinic visits for atopic dermatitis (AD) or itch and prescribed medications for AD management. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional time-series study assessed the associations of air pollution resulting from the California Camp Fire in November 2018 and 8049 dermatology clinic visits (4147 patients) at an academic tertiary care hospital system in San Francisco, 175 miles from the wildfire source. Participants included pediatric and adult patients with AD or itch from before, during, and after the time of the fire (October 2018 through February 2019), compared with those with visits in the same time frame of 2015 and 2016, when no large wildfires were near San Francisco. Data analysis was conducted from November 1, 2019, to May 30, 2020. EXPOSURES: Wildfire-associated air pollution was characterized using 3 metrics: fire status, concentration of particulate matter less than 2.5 μm in diameter (PM2.5), and satellite-based smoke plume density scores. MAIN OUTCOMES AND MEASURES: Weekly clinic visit counts for AD or itch were the primary outcomes. Secondary outcomes were weekly numbers of topical and systemic medications prescribed for AD in adults. RESULTS: Visits corresponding to a total of 4147 patients (mean [SD] age, 44.6 [21.1] years; 2322 [56%] female) were analyzed. The rates of visits for AD during the Camp Fire for pediatric patients were 1.49 (95% CI, 1.07-2.07) and for adult patients were 1.15 (95% CI, 1.02-1.30) times the rate for nonfire weeks at lag 0, adjusted for temperature, relative humidity, patient age, and total patient volume at the clinics for pediatric patients. The adjusted rate ratios for itch clinic visits during the wildfire weeks were 1.82 (95% CI, 1.20-2.78) for the pediatric patients and 1.29 (95% CI, 0.96-1.75) for adult patients. A 10-μg/m3 increase in weekly mean PM2.5 concentration was associated with a 7.7% (95% CI, 1.9%-13.7%) increase in weekly pediatric itch clinic visits. The adjusted rate ratio for prescribed systemic medications in adults during the Camp Fire at lag 0 was 1.45 (95% CI, 1.03-2.05). CONCLUSIONS AND RELEVANCE: This cross-sectional study found that short-term exposure to air pollution due to the wildfire was associated with increased health care use for patients with AD and itch. These results may provide a better understanding of the association between poor air quality and skin health and guide health care professionals' counseling of patients with skin disease and public health practice.

Published
2021

38. Additional file 1 of Phenotypic overlap between atopic dermatitis and autism

Author

Shin, Kyong-Oh, Crumrine, Debra A., Kim, Sungeun, Lee, Yerin, Kim, Bogyeong, Abuabara, Katrina, Park, Chaehyeong, Uchida, Yoshikazu, Wakefield, Joan S., Meyer, Jason M., Jeong, Sekyoo, Park, Byeong Deog, Park, Kyungho, and Elias, Peter M.

Abstract

Additional file 1: Figure S1. Identification of ASD-like abnormalities in VPA-exposed mice by Morris water maze test: neonatal VPA-exposed mice (7 days of age) were given 4 trials/day to find the target platform, when starting from the four cardinal points around the circumference of the pool. A Latency to find the platform in ASD and control mice. B Representative searching tracks by swimming mice. Figure S2. Demonstration of epidermal permeability barrier abnormality in VPA-exposed mice. Permeability barrier assessment with low molecular weight, water-soluble tracer, lanthanum nitrate (curved arrow depicts outward movement of tracer) leaking into SC interstices, non-curved arrows depict tracer in SC interstices. Mag Bar = 1 µm. Figure S3. Basis for impaired cutaneous barrier function in VPA-exposed mice. A Normal extracellular bilayers (arrows) in stratum corneum (SC) of Veh-treated mice. B Abnormal lamellar bilayer organization (asterisk; open arrows) in VPA-exposed mice. C Impaired secretion in VPA-exposed mice, evidenced by a reduction in secreted lamellar body contents at stratum granulosum (SG)-SC interface, as well as entombed (non-secreted) lamellae in SC cytosol (open arrows). Figure S4. Representative H&E stained brain sections (400× total magnification) from 1 day (1D) and 4 day (4D) old mice from Veh (A, B) or VPA (C, D)—treated female mice. Scattered microglia (white arrows) and neutrophils (yellow arrows) are present within white matter parenchyma. Very few mast cells or other inflammatory cells are observed. Figure S5. Sequential changes in additional Th-2 cytokine levels. A–D Higher levels of TNFα and IL-13 in skin in comparison to brain at birth in VPA-exposed mice. E, F Comparable levels of IFNγ in skin and brain at birth. Figure S6. Immunofluorescence localization of TNFα, IFNγ and Il-13 in skin. A–C Paraffin-embedded skin sections (5 µm) from 1-day old VPA-and vehicle (Veh)-exposed mice were labelled with rabbit anti-mouse TNFα, IFNγ or IL-13 primary antibodies (vs. no primary antibody), followed by Alexa Fluor 594 (red) conjugated donkey anti-rabbit secondary antibody, and visualized by confocal fluorescence microscopy. DAPI (blue) was used as a nuclear counterstain. Dashed lines indicate dermo-epidermal junction, and solid lines indicate the uppermost layer of the stratum corneum (SC). D Quantitation of IFNγ immunostaining in skin of 1-and 4-day-old VPA-vs. vehicle (Veh)-exposed neonates. Figure S7. Epidermal functions in ASD subjects: cutaneous barrier function [assessed as transepidermalwater loss (TEWL)] and skin hydration (assessed by corneometry) were measured in 25 ASD volunteers (average age = 19). Though the differences between the three groups as a whole did not reach statistical significance, barrier function and skin hydration declined in a subset of volunteers with ASD, even in absence of concurrent AD or history of prior AD. Figure S8. Proposed sequence for barrier-induced provocation of cytokine cascade in AD that could ‘drive’ ASD.

Published
2021
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39. Atopic eczema and obesity: a population-based study

Author

Ascott, Anna, Mansfield, Kathryn, Schonmann, Yochai, Mulick, Amy, Abuabara, Katrina, Roberts, Amanda, Smeeth, Liam, and Langan, Sinéad

Subjects
body regions, immune system diseases, otorhinolaryngologic diseases
Abstract

Background Atopic eczema is a common chronic inflammatory skin disease. Research suggests an association between atopic eczema and obesity, with inconsistent evidence from European populations. Objectives To explore the association between diagnosed atopic eczema and being overweight or obese, and whether increased atopic eczema severity was associated with higher body mass index. Methods We undertook a cross-sectional analysis within a matched (age, sex, GP practice) cohort of adults with and without a diagnosis of atopic eczema. We used primary care (Clinical Practice Research Datalink Gold) and linked hospital admissions data (1998-2016). We used conditional logistic regression to compare the odds of being overweight or obese (adjusting for confounders and potential mediators) in those with atopic eczema (mild, moderate and severe, and all eczema) to those without. Results We identified 441,746 people with atopic eczema, matched to 1,849,722 without. People with atopic eczema had slightly higher odds of being overweight or obese compared to those without (OR 1.08, 95% CI 1.07, 1.09) after adjusting for age, asthma and socio-economic deprivation. Adjusting for potential mediators (high-dose glucocorticoids, harmful alcohol use, anxiety, depression, smoking) had minimal effect on effect estimates (OR 1.07, 95% CI 1.06, 1.08). We saw no evidence that odds of being overweight or obese increased with increasing atopic eczema severity, and there was no association in people with severe eczema. Conclusion We found evidence of a small overall association between atopic eczema and being overweight or obese. However, there was no association with obesity among those with the most severe eczema. Our findings are largely reassuring for this prevalent patient group that may already have an increased risk of cardiovascular disease.

Published
2020

40. Barriers to contraceptive use in product labeling and practice guidelines

Author

Grossman, Daniel, Ellertson, Charlotte, Abuabara, Katrina, Blanchard, Kelly, and Rivas, Francisco T.

Subjects
Contraceptives -- Usage, Contraceptives -- Labeling, Evidence-based medicine -- Analysis, Women -- Health aspects, Government, Health care industry
Abstract

Many contraceptives are encumbered with potentially unnecessary restrictions on their use. Indeed, fear of side effects, fostered by alarmist labeling, is a leading reason that women do not use contraceptives. In the United States, hormonal methods currently require a prescription, although research suggests that women can adequately screen themselves for contraindications, manage side effects, and determine an appropriate initiation date, leaving little need for routine direct physician involvement. Sizing, spermicidal use, and length-of-wear limits burden users of cervical barriers and may be unnecessary. Despite recent changes in the labeling of intrauterine devices, clinicians commonly restrict use of this method and in some countries may limit the types of providers authorized to insert them. Although in some cases additional research is necessary, existing data indicate that evidence-based demedicalization of contraceptive provision could reduce costs and improve access. (doi:10.2105/AJPH.2004.040774)

Published
2006

43. Clinical onset of atopic eczema:Results from 2 nationally representative British birth cohorts followed through midlife

Author

Abuabara, Katrina, Ye, Morgan, McCulloch, Charles E, Sullivan, Alice, Margolis, David J, Strachan, David P, Paternoster, Lavinia, Yew, Yik Weng, Williams, Hywel C, and Langan, Sinéad M

Subjects
Adult, Male, Adolescent, Allergy, Immunology, atopic eczema, Dermatitis, Filaggrin Proteins, Article, Atopic, Dermatitis, Atopic, Cohort Studies, Young Adult, Clinical Research, 2.3 Psychological, immune system diseases, otorhinolaryngologic diseases, Humans, 2.1 Biological and endogenous factors, Longitudinal Studies, Aetiology, skin and connective tissue diseases, Child, Preschool, Skin, FLG, Filaggrin, Pediatric, BCS, British Cohort Study, atopic dermatitis, Prevention, Infant, Newborn, Infant, Middle Aged, Newborn, body regions, England, natural history, Child, Preschool, UK, United Kingdom, Atopic eczema, Female, epidemiology, Self Report, social and economic factors, OR, Odds ratio, 2.4 Surveillance and distribution
Abstract

Background Atopic eczema onset is described primarily in early childhood, and the frequency and characteristics of adult-onset disease remain controversial. Objective We sought to determine the proportion of subjects who report atopic eczema symptoms between birth and midadulthood and to examine demographic, immunologic, and genetic factors associated with period of symptom onset. Methods We conducted a longitudinal study using data from 2 nationally representative community-based birth cohorts from the United Kingdom: the British Cohort Studies 1958 and 1970. Subjects were followed from birth through age 42 to 50 years. The primary outcome was the age period of self-reported atopic eczema symptom onset based on repeated measures of self-reported atopic eczema at each survey wave. Results The annual period prevalence of atopic eczema ranged from 5% to 15% in 2 cohorts of more than 17,000 participants each followed from birth through middle age. There was no clear trend in prevalence by age, and among adults reporting active atopic eczema during a given year, only 38% had symptom onset reported in childhood. When compared with subjects whose eczema started in childhood, those with adult-onset disease were more likely to be women, from Scotland or Northern England, of lower childhood socioeconomic group, smokers in adulthood, and less likely to have a history of asthma. In a subanalysis using data from the 1958 cohort only, genetic mutations previously associated with atopic eczema, including filaggrin-null mutations, and allergen-specific IgE were more common among those with childhood-onset disease. Conclusion Rates of self-reported atopic eczema remain high after childhood, and adult-onset atopic eczema has different risk factor associations than childhood-onset eczema., Graphical abstract

Published
2019

44. Association of Atopic Dermatitis With Sleep Quality in Children

Author

Ramirez, Faustine D, Chen, Shelley, Langan, Sinéad M, Prather, Aric A, McCulloch, Charles E, Kidd, Sharon A, Cabana, Michael D, Chren, Mary-Margaret, and Abuabara, Katrina

Abstract

Importance: Pruritus, a hallmark of atopic dermatitis (AD), is thought to disrupt sleep, yet little is known about how variations in disease activity and severity of this common childhood condition may be associated with sleep patterns over time. Objective: To determine whether children with active AD have impaired sleep duration and quality at multiple time points throughout childhood and whether disease severity affects sleep outcomes. Design, Setting, and Participants: This longitudinal cohort study used data of children enrolled in the Avon Longitudinal Study of Parents and Children, a population-based birth cohort in Avon, United Kingdom. Participants were children (N = 13 988) alive at 1 year and followed up with repeated measures of self-reported AD and sleep through 16 years of age. This study was based on data collected from 1990 to 2008. Data analysis was performed from September 2017 to September 2018. Main Outcomes and Measures: Standardized measure of sleep duration and composite measure of sleep quality, including nighttime awakenings, early morning awakenings, difficulty falling asleep, and nightmares, were repeated at multiple time points between 2 and 16 years of age. Results: The study sample comprised 13 988 children (7220 male [51.6%]) followed up for a median (interquartile range [IQR]) duration of 11 (5-14) years. Of this total, 4938 children (35.3%) met the definition of having atopic dermatitis between 2 and 16 years of age. Total sleep duration was similar between children with active AD and without AD at all ages, and the average estimated difference across childhood was a clinically negligible difference of 2 minutes less per day for children with AD (95% CI, -4 to 0 minutes). In contrast, children with active AD were more likely to report worse sleep quality at all time points, with a nearly 50% higher odds of experiencing more sleep-quality disturbances (adjusted odds ratio [aOR], 1.48; 95% CI, 1.33 to 1.66). Children with more severe active disease (quite bad or very bad AD: aOR, 1.68; 95% CI, 1.42 to 1.98) and with comorbid asthma or allergic rhinitis (aOR, 1.79; 95% CI, 1.54 to 2.09) had worse sleep quality. However, even children with mild AD (OR, 1.40; 95% CI, 1.27 to 1.54) or inactive AD (OR, 1.41; 95% CI, 1.28 to 1.55) had statistically significantly increased odds of impaired sleep quality. Conclusions and Relevance: Atopic dermatitis appeared to be associated with impaired sleep quality throughout childhood; thus, it is suggested that clinicians should consider sleep quality among all children with AD, especially those with comorbid asthma or allergic rhinitis and severe disease, and that interventions to improve sleep quality are needed.

Published
2019

45. Atopic eczema and major cardiovascular outcomes: A systematic review and meta-analysis of population-based studies

Author

Ascott, Anna, Mulick, Amy, Yu, Ashley M., Prieto-Merino, David, Schmidt, Morten, Abuabara, Katrina, Smeeth, Liam, Roberts, Amanda, and Langan, Sinéad M.

Subjects
angina, myocardial infarction, atopic dermatitis, ischemic stroke, heart failure, risk factors, Atopic eczema, cardiovascular death, stroke, cardiovascular outcomes
Abstract

Background: Atopic eczema is a common inflammatory skin disease. Various inflammatory conditions have been linked to cardiovascular disease, a major cause of global mortality and morbidity. Objective: We sought to systematically review and meta-analyze population-based studies assessing associations between atopic eczema and specific cardiovascular outcomes. Methods: MEDLINE, Embase, and Global Health were searched from inception to December 2017. We obtained pooled estimates using random-effects meta-analyses. We used a multivariate Bayesian meta-regression model to estimate the slope of effect of increasing atopic eczema severity on cardiovascular outcomes. Results: Nineteen relevant studies were included. The effects of atopic eczema reported in cross-sectional studies were heterogeneous, with no evidence for pooled associations with angina, myocardial infarction, heart failure, or stroke. In cohort studies atopic eczema was associated with increased risk of myocardial infarction (n = 4; relative risk [RR], 1.12; 95% CI, 1.00-1.25), stroke (n = 4; RR, 1.10; 95% CI, 1.03-1.17), ischemic stroke n = 4; RR, 1.17; 95% CI, 1.14-1.20), angina (n = 2; RR, 1.18; 95% CI, 1.13-1.24), and heart failure (n = 2; RR, 1.26; 95% CI, 1.05-1.51). Prediction intervals were wide for myocardial infarction and stroke. The risk of cardiovascular outcomes appeared to increase with increasing severity (mean RR increase between severity categories, 1.15; 95% credibility interval, 1.09-1.21; uncertainty interval, 1.04-1.28). Conclusion: Significant associations with cardiovascular outcomes were more common in cohort studies but with considerable between-study heterogeneity. Increasing atopic eczema severity was associated with increased risk of cardiovascular outcomes. Improved awareness among stakeholders regarding this small but significant association is warranted.

Published
2018

47. Severe and predominantly active atopic eczema in adulthood and long term risk of cardiovascular disease:population based cohort study

Author

Silverwood, Richard J, Forbes, Harriet J, Abuabara, Katrina, Ascott, Anna, Schmidt, Morten, Schmidt, Sigrún A J, Smeeth, Liam, and Langan, Sinéad M

Subjects
Adult, Aged, 80 and over, Male, Adolescent, Angina, Unstable/etiology, Research, Dermatitis, Atopic/complications, Middle Aged, Severity of Illness Index, body regions, Cohort Studies, Young Adult, Atrial Fibrillation/etiology, Risk Factors, Myocardial Infarction/etiology, Humans, Female, Cardiovascular Diseases/etiology, Aged
Abstract

OBJECTIVE: To investigate whether adults with atopic eczema are at an increased risk of cardiovascular disease and whether the risk varies by atopic eczema severity and condition activity over time.DESIGN: Population based matched cohort study.SETTING: UK electronic health records from the Clinical Practice Research Datalink, Hospital Episode Statistics, and data from the Office for National Statistics, 1998-2015.PARTICIPANTS: Adults with a diagnosis of atopic eczema, matched (on age, sex, general practice, and calendar time) to up to five patients without atopic eczema.MAIN OUTCOME MEASURES: Cardiovascular outcomes (myocardial infarction, unstable angina, heart failure, atrial fibrillation, stroke, and cardiovascular death).RESULTS: 387 439 patients with atopic eczema were matched to 1 528 477 patients without atopic eczema. The median age was 43 at cohort entry and 66% were female. Median follow-up was 5.1 years. Evidence of a 10% to 20% increased hazard for the non-fatal primary outcomes for patients with atopic eczema was found by using Cox regression stratified by matched set. There was a strong dose-response relation with severity of atopic eczema. Patients with severe atopic eczema had a 20% increase in the risk of stroke (hazard ratio 1.22, 99% confidence interval 1.01 to 1.48), 40% to 50% increase in the risk of myocardial infarction, unstable angina, atrial fibrillation, and cardiovascular death, and 70% increase in the risk of heart failure (hazard ratio 1.69, 99% confidence interval 1.38 to 2.06). Patients with the most active atopic eczema (active >50% of follow-up) were also at a greater risk of cardiovascular outcomes. Additional adjustment for cardiovascular risk factors as potential mediators partially attenuated the point estimates, though associations persisted for severe atopic eczema.CONCLUSIONS: Severe and predominantly active atopic eczema are associated with an increased risk of cardiovascular outcomes. Targeting cardiovascular disease prevention strategies among these patients should be considered.

Published
2018

49. Association between childhood allergic diseases, educational attainment and occupational status in later life : systematic review protocol

Author

von Kobyletzki, Laura B., Beckman, Linda, Smeeth, Liam, McKee, Martin, Quint, Jennifer K., Abuabara, Katrina, Langan, Sinead, von Kobyletzki, Laura B., Beckman, Linda, Smeeth, Liam, McKee, Martin, Quint, Jennifer K., Abuabara, Katrina, and Langan, Sinead

Abstract

Introduction Childhood allergic diseases may prevent affected children from achieving their academic potential. Potential mechanisms include absence from school due to illness and medical appointments. Experience of symptoms in classes or leisure time, and stigma associated with visible signs and symptoms, including skin disease, requirements for medication during school time or the need for specific diets, may also contribute to reduced educational attainment. Studies have investigated the association between specific allergic diseases and educational attainment. The aim of this study is to systematically review the literature on allergic diseases, educational attainment and occupational status, and if possible, calculate meta-analytic summary estimates for the associations. Methods Systematic electronic searches in Medline, EMBASE, Cochrane, Cumulative Index to Nursing & Allied Health Literature (CINAHL), PsycINFO and education Resources Information Center (ERIC); hand search in reference lists of included papers and conference reports; search for unpublished studies in clinical trial registers and the New York Academy of Medicine Grey Literature Report; data extraction; and study quality assessment (Newcastle-Ottawa Scale) will be performed. Analysis Data will be summarised descriptively, and meta-analysis including meta-regression to explore sources of heterogeneities will be performed if possible. Ethics and dissemination Dissemination in a peer-reviewed, open-access, international scientific journal is planned.

Published
2017
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