Eczema, an itchy skin disease that is common in both children and adults, may increase the risk of developing other health problems. The research on this topic has shown potential links with a number of diseases, such as asthma, heart disease, broken bones, and others, but for many of these researchers are only moderately certain, or uncertain, that links with eczema actually exist. Data from general practice in the UK is suitable to perform studies on this topic, as they contain information about many different diseases from millions of people, but so far researchers have mostly studied one disease at a time, e.g. does eczema increase the risk of breaking a bone, having an issue with the heart, or getting a skin infection. Each of these investigations is costly in time and money and results may not be directly comparable to another. With this project we will systematically and consistently study diseases linked to eczema which has many advantages in terms of cost, efficiency and trustworthiness of results. This leap in efficiency can be achieved by reducing unnecessary differences between individual studies, while still allowing us to input clinical knowledge and expertise. This will allow us to efficiently update our knowledge on the topic and increase how certain we can be about links between eczema and other diseases, making it easier for doctors and public health decision makers to implement better standards of preventive care and increasing the awareness of risks people with eczema may face.
Eczema may be related to a number of adverse health outcomes, however for most outcomes there is only low/moderate certainty evidence, some outcomes may be unknown, and studies employed heterogenous approaches to study design, analysis and data management, making results difficult to compare. Uncertainties should be addressed to improve patient management including implementing screening and preventive measures. Population-based cohort studies using longitudinal routinely collected data are well suited for exploring adverse health outcomes however their conduct one outcome at a time is inefficient. Conducting these studies within a research pipeline minimising unnecessary heterogeneity between studies, while preserving the ability to incorporate the required expert knowledge and critical thinking, will efficiently and quickly allow us to generate evidence on multiple important health-related questions, with a higher level of clinical relevance due to comparability between outcomes.
We will develop a matched cohort research pipeline, fitting multiple adjusted (for age, sex, deprivation, smoking, BMI, oral corticosteroids, outcomes at baseline) Cox models to estimate hazard ratios for each outcome comparing people with eczema to people without. We will examine different age-groups (any age, >=18, >40) depending on the outcome under investigation, and perform multiple sensitivity analyses varying study time-frames, matching strategy, and using CPRD Aurum without HES. We will assess the role of eczema severity in secondary analyses.
Using this pipeline, we will explore associations between eczema and previously explored and unexplored adverse health outcomes. The choice of outcomes will be guided by findings from a recent large-scale review of the previous evidence. We will use CPRD Aurum linked to Hospital Episode Statistics, ONS death registration records and Index of multiple deprivation data. Thus, we will create a high-quality evidence source on adverse health outcomes associated with eczema while describing an approach adaptable to other skin diseases and other areas of research.
Asthma; Food allergies; Allergic rhinitis; Allergic conjunctivitis; Eosinophilic esophagitis; Alopecia areata; Urticaria; Depression; Anxiety; Alcohol abuse; ADHD; Autism spectrum disorders; Hypertension; Coronary artery disease; Peripheral artery disease; Myocardial infarction; Stroke; Congestive heart failure; Thromboembolic diseases; Obesity; Diabetes; Metabolic syndrome; Bone fractures; Osteoporosis; Skin infections; Cancer; Dementia; Abdominal Hernia; Alcoholic Liver Disease; Anal Fissure; Angiodysplasia of colon; Anorectal Fistula; Anorectal Prolapse; Appendicitis; Autoimmune liver disease; Barrett's Oesophagus; Cholangitis; Cholecystitis; Cholelithiasis; Cirrhosis; Coeliac Disease; Crohn’s Disease; Diaphragmatic Hernia; Diverticular Disease; Fatty Liver; Gastritis; Gastro-oesophageal Reflux Disease; Irritable Bowel Syndrome; Oesophageal Ulcer; Oesophageal Varices; Pancreatitis; Peptic Ulcer; Peritonitis; Portal Hypertension; Ulcerative Colitis; Volvulus; Bell's Palsy; Cerebral Palsy; Epilepsy; Essential Tremor; Intracranial Hypertension; Migraine; Motor Neurone Disease; Multiple Sclerosis; Myasthenia Gravis; Parkinson's Disease; Peripheral Neuropathy; Trigeminal Neuralgia; Herpes Zoster & Post-herpetic Neuralgia
Julian Matthewman - Chief Investigator - London School of Hygiene & Tropical Medicine ( LSHTM )
Julian Matthewman - Corresponding Applicant - London School of Hygiene & Tropical Medicine ( LSHTM )
Anna Schober - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Anna Schultze - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Helen Strongman - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Jennifer Banks - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Krishnan Bhaskaran - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Sinead Langan - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Spiros Denaxas - Collaborator - University College London ( UCL )
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation