Social disadvantage and the association between atopic dermatitis severity and cognitive performance in children

Summary: Abstract Body: Atopic dermatitis (AD) has been linked to cognitive concerns in children, but the role of socioeconomic factors in this association remains unclear. Thus, this study examined the contribution of social disadvantage to the relationship between AD severity and cognition. In 77 children aged 3-17 years seen for AD at our institution, cognitive performance was assessed via the NIH Toolbox (NIHT) Cognition Battery, and recent AD severity was self-reported (20 mild, 34 moderate, 23 severe). Social disadvantage was approximated by the Area Deprivation Index (ADI), which provides a state decile (sADI) ranking of neighborhoods by socioeconomic disadvantage. sADI was further dichotomized into high or low disadvantage at the median. Participants’ age-corrected NIHT Composite Total Cognition Scores (CTCS) were lower (i.e., worse performance) than the normative mean of 100 (median [IQR]: 94 [82-107], p = 0.01), particularly for severe AD (83.5 [80–91], p < 0.001), with scores declining with more severe disease (p for trend = 0.004). When adjusted for sex and sADI, severe AD remained associated with lower CTCS compared to mild AD (β: -12.8, 95% CI [-22.9, -2.6]). In analyses stratified by high vs low ADI, this association between severe AD and lower CTCS remained in both the high ADI subgroup (adjusted β: -13.3, 95% CI [-29.8, 3.2]) and low ADI subgroup (adjusted β: -14.4, 95% CI [-30.0, 1.3]). Tests for statistical interaction between sADI and AD severity showed significance within the high ADI subgroup only (p = 0.04). Our findings suggest that recently severe AD is associated with poorer cognitive performance in children independent of social disadvantage. However, the AD-cognition relationship may also be modified by ADI, whereby greater social disadvantage may interact with severe AD to further impair cognitive performance among individuals living in more disadvantaged neighborhoods. Further research is needed to better characterize the potential interactions between AD severity and individual socioeconomic factors on cognitive outcomes. Sumrah Jilani¹, R Urbonas¹, K Kartawira¹, H-J Su¹, A Grossberg¹, R Wood¹, Joy Wan¹ 1. Johns Hopkins University, Baltimore, MD, United States. Clinical Research: Epidemiology and Observational Research