Content and construct validity, predictors, and distribution of self-reported atopic dermatitis severity in US adults.

Abstract

BACKGROUND:

Atopic dermatitis (AD) is associated with skin lesions, multiple symptoms, and effect of quality of life, all of which factor into disease severity. Self-reported global AD severity may be a valid severity assessment for epidemiologic research.

OBJECTIVE:

To validate self-reported global AD severity in a representative cohort of adults with AD.

METHODS:

Preliminary probing-cognitive interviews were performed (n = 8). Next, a cross-sectional US population-based survey study of adults with AD was performed. AD was diagnosed using an adap/tation of the UK Working Party criteria (n = 602). AD severity was assessed using self-reported global AD severity (mild, moderate, severe), Patient-Oriented Scoring AD (PO-SCORAD), Patient-Oriented Eczema Measure (POEM), Numeric Rating Scale (NRS)-itch, NRS-sleep, NRS-pain, and Hospital Anxiety and Depression Scale (HADS).

RESULTS:

Self-reported global AD severity had good content validity. Self-reported global AD severity had strong correlations with PO-SCORAD (Spearman correlation ρ = 0.61) and objective PO-SCORAD (ρ = 0.61); moderate correlations with POEM (ρ = 0.54), NRS-itch (ρ = 0.44), NRS-pain (ρ = 0.46), and HADS (ρ = 0.41); and weak correlation with NRS-sleep (ρ = .32) (P < .001 for all). Consistent and significant correlations were observed in stratified analyses by age, sex, race/ethnicity, and level of education. There were stepwise increases of PO-SCORAD, NRS-itch, NRS-sleep, NRS-pain, POEM, and HADS with increasing self-reported global AD severity (Kruskal-Wallis test, P < .01). There was weak-moderate concordance between self-reported AD severity and established severity strata for PO-SCORAD (ρ = 0.44), NRS-itch (ρ = 0.30), and POEM (ρ = 0.43). Rather, self-reported global AD severity was best predicted by a combination of PO-SCORAD, POEM, NRS-itch, NRS-pain, and HADS. No differential item reporting was found by age, sex, or race/ethnicity.

CONCLUSION:

Self-reported AD severity simultaneously assesses multiple AD constructs and appears to be sufficiently valid for assessing AD severity in clinical and epidemiologic studies.

• Authors: Jonathan I Silverberg, Zelma C Chiesa Fuxench, Joel M Gelfand, David J Margolis, Mark Boguniewicz, Luz Fonacier, Mitchell H Grayson, Eric L Simpson, Peck Y Ong
• Journal: Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (Ann Allergy Asthma Immunol) Vol. 121 Issue 6 Pg. 729-734.e4 (12 2018) ISSN: 1534-4436 [Electronic] United States
• PMID: 30092267 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Validation Study)
• Copyright: Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Child
• Child, Preschool
• Cross-Sectional Studies
• Dermatitis, Atopic (diagnosis)
• Female
• Humans
• Infant
• Male
• Middle Aged
• Pain (diagnosis)
• Self Report (statistics & numerical data)
• Severity of Illness Index
• Skin (pathology)
• United States