Prevalence, Incidence and Predictive Factors for Hand Eczema in Young Adults

A Follow-Up Study

Arne Johannisson; Ann Pontén; Åke Svensson

Disclosures

BMC Dermatol. 2013;13(14) 

In This Article

Results

The flow-chart of the cohort is shown in Figure 1. Out of the 2,403 participants from the original cohort who received a questionnaire in the mail, 1,516 responded to the questionnaire, which was a response rate of 63%; 56% of the respondents were females. Significantly more females than males answered the questionnaire, 69.4% of the reachable original female cohort and 56.4% of the males (p < 0.001). However, in 2008 there were no significant differences between the respondents and non-respondents in reporting 1-year prevalence of hand eczema in 1995 (p = 0.677). No significant differences were found within the genders in reported hand eczema in 1995 (females, p = 0.490; males, p = 0.297).

In the first dispatch, 899 (37%) responded, the first postcard reminder yielded 158 (10%) responses. On the second reminder 437 (32%) responded. With the final postcard reminder, 22 (2%) responded, which left 887 non-respondents.

One-year Prevalence of Hand Eczema

The 1-year prevalence of hand eczema in 2008 was 15.8%, Figure 2; females reported hand eczema twice as often as males, 20.3% versus 10.0%, (p < 0.001). The estimated true 1-year prevalence for this cohort was: (0.158 + (0.99 – 1))/(0.73 + (0.99 – 1)) = 20.6%, 26.8% for females and 12.5% for males.The 1516 participants were allocated to any of the four groups as previously defined; HX9508 (83/1516, 5.5%, 7.2% females and 3.2% males), HX95 (71/1516, 4.7%; 5.6% females and 3.5% males), HX08 (157/1516, 10.4%; 13.1% females and 6.8% males) and NoHX (1016/1516, 67.0%; 61.4% females and 74.4% males). One hundred and sixty respondents (10.6%) reported that they had had hand eczema at some time, but not in 1995 nor in 2008, 29 individuals, 1.9%, did not answer the question. The higher proportion of females compared with males in the hand eczema groups compared with the NoHX group was significant (p < 0.001).

Figure 2.

The proportions reporting hand eczema in 1995 but not 2008 (HX95), both 1995 and 2008 (HX9508), and only 2008 (HX08).

Incidence of Hand Eczema

In 1995 in total 13.3% (202/1516) reported they had or had had hand eczema, 139 females, (16.2%) and 63 males (9.6%), p < 0.001. In 2008 an additional 198 individuals reported themselves having or having had hand eczema. Thus the cumulative incidence over the 13 years was 15.1% (198/1314), for the females 18.6% and for the males 10.7%, p < 0.001. The incidence rate was estimated as 11.6 cases per 1000 person-years, 14.3 for females and 5.2 for males (p < 0.001).

Hand Eczema versus Childhood Eczema, Asthma, Rhino-conjunctivitis and Gender

Childhood eczema was reported by 400/1516 (26.4%) of the participants. The proportions of having had childhood eczema, asthma and rhino-conjunctivitis in the four groups in total and by gender for 2008 are shown in Table 1. The proportions of the individuals reporting only childhood eczema; i.e. not in combination with asthma and/or rhino-conjunctivitis (146/1516, 9.6%), were found to be: HX9508, 73.9%; HX95, 41.7%, HX08, 45.5% and NoHX, 17.3% (p < 0.001). Only having had asthma was reported by 22/1516 (1.5%); within the groups: 1, 1, 0 and 20 individuals respectively, (p = 0.366). Only having had rhino-conjunctivitis was reported by 201/1516 (13.3%). Within the groups 4, 7, 11 and 179 individuals, respectively (p = 0.124).

Self-reported Childhood Eczema in 2008 Compared to 1995

The question about childhood eczema was answered by 1323 of the 1516 respondents (87.3%) in 2008. In 1995, 297/1323 individuals (22.4%) reported childhood eczema, and 239 of these gave the same answer in 2008. This gives the positive predictive value (PPV) of 80.5% (239/297). The negative predictive value (NPV), i.e. reporting not having had childhood eczema in 1995 as well as in 2008, was 76.7% (610/795). When comparing genders, the PPV for females was 82.3% and the NPV was 77.0%. The PPV for males was 75.6% and the NPV was 76.5%. There were significant differences within three of the four groups between PPV and NPV; HX9508 group: PPV = 90.6% and NPV = 35.0% (p = 0.016); HX95 group: PPV = 76.7% and NPV = 60.7% (p = 0.611); HX08 group: PPV = 94.0% and NPV = 55.3% (p < 0.001); NoHX group: PPV = 73.8% and NPV = 77.6% (p < 0.001).

Hand Eczema and Exogenous Factors

The results regarding potential exogenous risk factors for developing hand eczema are shown in Table 2. The individuals in the HX group reported a significantly higher frequency of hand washing compared to the NoHX group, mean 15.4 versus 11.7 times per day (p < 0.001). The females in the HX group had a significantly higher number of daily hand washing compared to the females in the NoHX-group, 17.4 versus 14.5 times per day (p < 0.001).

Concerning skin care, daily use of moisturisers was reported by 60.5% in the HX group (females 67.6% males 41.5%), and by 30.6% in the NoHX group (females 47.4% and males 12.7%). The differences were significant between the two groups and between the genders within the groups (p < 0.001). Regardless of hand eczema, females used moisturisers significantly more often than males; 52.9% female versus 16.2% male daily users (p < 0.001), However, having hand eczema raised the reported usage of moisturizers by a factor 1.4 for females and 3.3 for males.

The exogenous factors were analysed between all four groups, in total as well as between genders (HX9508, HX95, HX08 and NoHX) and within genders in all groups, Table 3. In total as well as within females, the HX08 group had a significantly higher frequency of hand washing at home and at work than the NoHX group (p < 0.001). Regarding time spent at ordinary work; the HX08 group worked significantly less than the NoHX group (p = 0.001). The HX08 group spent significantly more time cooking, cleaning and doing laundry than the NoHX group. The HX08 group smoked significantly more cigarettes than those in the HX9508 and NoHX groups (p = 0.023 and 0.012 respectively).

Among the respondents 487/1323 (36.8%) used moisturisers daily. The HX9508 group used moisturisers significantly more than the other groups, 71.1%, followed by the HX08 group, 54.8%, the HX95group, 45.7% and the NoHX group, 30.6%, (p < 0.001). Among females 52.7% (n = 746), used moisturisers every day; 79% in the HX9508 group, 61.3% in the HX08 group, 56.2% in the HX95 group and 47.4% in the NoHX group (p < 0.001). Among males 16.3% used moisturisers daily: 47.6% in the HX9508 group, 38.6% in the HX08 group, 22.7% in the HX95 group and 12.7% in the NoHX group (p < 0.001). Males with hand eczema used moisturisers as often as women without hand eczema.

Factors Predicting Hand Eczema

The analysis of endogenous and exogenous factors was performed with multinominal logistic regression. The results are shown in Table 4. Having had childhood eczema was the most significant predictor for 1-year prevalence of hand eczema 2008 with odds ratios of 13.17 in the group HX9508 and 5.17 in the group HX08 compared to the group NoHX. The frequency of daily hand washing was significantly associated with the 1-year prevalence of hand eczema only in the HX08 group. The daily usage of moisturisers was significantly associated with 1-year prevalence of hand eczema in the groups HX9508 and HX08. High odds ratios, 1.40, for predicting 1-year prevalence of hand eczema was found for female gender in the group HX9508. In the group HX08 the higher odds ratio for females was 1.19. However, none of these differences were significant.

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