Atopic dermatitis and risk of ischemic stroke: A nationwide population-based study

Figures & data

Table I. Baseline characteristics of patients with atopic dermatitis (AD) and matched cohort.

	Patients with AD (n = 20,323)		Matched cohort (n = 20,323)
Characteristics	n	%	n	%	P
Age, y, median (interquartile range)	40 (29–54)		40 (29–54)
< 40	9,897	48.7	9,897	48.7
≥ 40	10,426	51.3	10,426	51.3
Female	12,583	61.9	12,583	61.9
Male	7,740	38.1	7,740	38.1
Diabetes mellitus	2,936	14.4	2,936	14.4
Atrial fibrillation	151	0.7	151	0.7
Hypertension	4,678	23.0	4,678	23.0
Coronary artery disease	209	1.0	209	1.0
Valvular heart disease	1,090	5.4	1,090	5.4
PAOD	54	0.3	54	0.3
Chronic kidney disease	1,657	8.2	1,657	8.2
Dyslipidemia	4,459	21.9	4,459	21.9
Lung cancer	97	0.5	88	0.4	0.556
COPD	3,570	17.6	3,044	15.0	< 0.001
Allergic rhinitis	7,078	34.8	5,647	27.8	< 0.001
Asthma	2,852	14.0	2,304	11.3	< 0.001
Psoriasis	345	1.7	195	1.0	< 0.001
Statins	1,180	5.8	1,258	6.2	0.103
ACEI/ARBs	1,960	9.6	1,965	9.7	0.932
Aspirin/clopidogrel	1,218	6.0	1,197	5.8	0.660
Warfarin	90	0.4	89	0.4	1

ACEI = angiotensin-converting enzyme inhibitor; ARBs = angiotensin II receptor-blockers; COPD = chronic obstructive pulmonary disease; PAOD = peripheral artery occlusive disease.

The P value for matched variables was not shown. Medications and five comorbidities (lung cancer, COPD, allergic rhinitis, asthma, and psoriasis) were not matched.

Figure 1. Cumulative incidence of ischemic stroke in patients with atopic dermatitis (AD) and matched cohort.

Table II. Predictors of ischemic stroke by Cox's proportional hazards regression analysis.

	Univariate analysis		Multivariate analysis
Variables	HR (95% CI)	P	HR (95% CI)	P
Atopic dermatitis	1.29 (1.09–1.54)	0.003	1.33 (1.12–1.59)	0.001
Age^a	1.09 (1.08–1.09)	< 0.001	1.07 (1.06–1.08)	< 0.001
Male sex	2.16 (1.82–2.56)	< 0.001	1.49 (1.25–1.78)	< 0.001
Comorbidities:
Diabetes mellitus	4.22 (3.55–5.02)	< 0.001	1.34 (1.10–1.62)	0.003
Atrial fibrillation	7.04 (4.67–10.60)	< 0.001
Hypertension	9.69 (7.98–11.75)	< 0.001	2.07 (1.63–2.63)	< 0.001
Coronary artery disease	6.26 (4.33–9.05)	< 0.001
Valvular heart disease	2.79 (2.17–3.58)	< 0.001	1.37 (1.05–1.79)	0.020
PAOD	5.31 (2.37–11.87)	< 0.001
Chronic kidney disease	3.32 (2.71–4.08)	< 0.001
Dyslipidemia	3.38 (2.85–4.01)	< 0.001
Lung cancer	4.31 (2.23–8.34)	< 0.001
COPD	3.65 (3.07–4.34)	< 0.001
Allergic rhinitis	0.90 (0.75–1.09)	0.278
Asthma	2.34 (1.92–2.86)	< 0.001
Psoriasis	1.65 (0.91–3.00)	0.099
Medications:
Statins	2.81 (2.23–3.55)	< 0.001
ACEI/ARBs	4.62 (3.85–5.53)	< 0.001
Aspirin/clopidogrel	5.72 (4.72–6.93)	< 0.001	1.34 (1.08–1.66)	0.007
Warfarin	5.29 (2.91–9.61)	< 0.001

All factors with P < 0.1 in univariate analyses were included in the Cox's multivariate analysis.

ACEI = angiotensin-converting enzyme inhibitor; ARBs = angiotensin II receptor-blockers; CI = confidence interval; COPD = chronic obstructive pulmonary disease; HR = hazard ratio; PAOD = peripheral artery occlusive disease.

^aHR for being 1 year older.

Table III. Risk factors for ischemic stroke, acute myocardial infarction (AMI), and heart failure (HF) in patients with atopic dermatitis and matched cohort.

Total CV eventsHR (95% CI)	P	Ischemic strokeHR (95% CI)^a	P	AMIHR (95% CI)^a	P	HFHR (95% CI)^a	P
1.32 (1.15–1.52)	< 0.001	1.30 (1.08–1.56)	0.005	1.31 (0.88–1.95)	0.180	1.46 (1.10–1.93)	0.009

All HRs were adjusted for age, sex, comorbidities and medications listed in Table I. All factors with P < 0.1 in univariate analyses were included in the Cox's multivariate analysis.

Total CV events = the sum of ischemic stroke and AMI and HF.

^aAfter adjusting for competing risk

AMI = acute myocardial infarction; CI = confidence interval; CV = cardiovascular; HF = heart failure; HR = hazard ratio.

Table IV. Association of the risk of developing ischemic stroke with dermatologist visits.

	Univariate analysis		Multivariate analysis^a
	HR (95% CI)	P	HR (95% CI)	P
Dermatologist visits
Last 3 months	1.07 (1.00–1.14)	0.059	1.01 (0.94–1.08)	0.799
Last 2 months	1.13 (1.03–1.23)	0.009	1.04 (0.95–1.14)	0.381
Last 1 month	1.28 (1.12–1.47)	< 0.001	1.12 (0.98–1.28)	0.088
Last 2 weeks	1.44 (1.11–1.88)	0.006	1.19 (0.93–1.54)	0.170
Last 1 week	1.72 (1.14–2.61)	0.010	1.29 (0.87–1.93)	0.211

^aAdjusted for age, sex, comorbidities, and medications listed in Table I.

CI = confidence interval; HR = hazard ratio.

Figure 2. Cumulative incidence of ischemic stroke in patients with mild, moderate, severe, and no atopic dermatitis (AD) group.