Epidemiology and comorbidities of patients with chronic urticaria in Taiwan‏: A nationwide population-based study

https://doi.org/10.1016/j.jdermsci.2017.07.006Get rights and content

Highlights

Abstract

Background

Comprehensive data regarding the epidemiology of chronic urticaria (CU) in general populations are scant.

Objectives

To investigate the prevalence, incidence, and comorbidities of CU in general population.

Methods

The data were sourced from the National Health Insurance Research Database (NHIRD) for 2009–2012. Patients who had a primary/secondary ICD-9-CM diagnosis code of 708.1, 708.8, or 708.9 during the year with at least two outpatient visits and an antihistamine prescription, were identified as the cases of CU for each year. The incidence, persistence and comorbidities of CU were examined.

Results

The prevalence of CU ranged from 0.69% to 0.79% for each year from 2009 to 2012, and the incidence was around 0.50% per year from 2010 to 2012. Comparing to the Standard Population, the standardized prevalence ratios (SPRs) for the rheumatic diseases, thyroid disorders, inflammatory diseases, and psychiatric disorders among CU patients were 2.74, 1.81, 1.57 and 1.87, respectively.

Conclusion

The prevalence of CU in Taiwan is about 0.69-0.79%. CU is associated with a significantly increased risk of psychiatric disorders, inflammatory diseases, thyroid disorders, and rheumatic diseases. Except for thyroid disorders, the prevalence of these comorbidities tends to increase the longer CU persists.

Introduction

Chronic urticaria (CU) is defined by the repeated occurrence of itchy hives, angioedema, or both, for 6 weeks or more. It is further classified into chronic inducible urticaria and chronic spontaneous (or idiopathic) urticaria (CSU/CIU), depending on whether a specific trigger can be identified or not [1], [2], [3]. Although urticaria is one of the most common skin conditions, only a few studies investigating the prevalence of CU have been published [4]. Most data have involved selected patient populations, usually patients attending special clinics [4], [5]. In addition, previous inconsistencies in the classification of CU present further difficulties when comparing past studies [4]. A 1-year period prevalence for CU of 0.8% was reported in a German study [5], while Gaig et al. reported a point prevalence of 0.6% in the Spanish population [6]. However, the prevalence and incidence of CU in Asian populations are largely unknown.

It has been suggested that CU might be related to other autoimmune processes, rheumatic diseases, or chronic inflammation [7], [8], [9]. The association of CU with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), ankylosing spondylitis (AS), psoriatic arthritis/psoriasis (PsA/PsO), thyroid disorders, inflammatory diseases, and psychiatric disorders has been reported before [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17]. However, there is limited information on how prevalent they are. In this study, we aimed to investigate the prevalence, incidence, and comorbidities of CU in the general population of Taiwan.

Section snippets

Setting

The National Health Insurance (NHI) program in Taiwan was put into effect in March of 1995, and is primarily funded by payroll tax premiums with additional subsidies from the general government revenues. The system covers 99.9% of the total population of Taiwan with a comprehensive benefits package (including preventive medicine, dental care services, outpatient and inpatient services, prescription drugs, and Chinese herbal remedies). Health care providers are reimbursed by the NHI for their

Results

There were 154,048, 159,637, 167,229, and 177,879 cases of CU identified in the NHIRD for the respective years from 2009 to 2012. The prevalence varied from 0.69% to 0.79% from 2009 to 2012, and the average incidence rate was about 0.50% from 2010 to 2012 (Fig. 2). Regarding to the patient profile of the 2012 CU cases, 56% of them were females and about 62% were 30–69 years old. The majority of CU patients was in the age of 40–59 years old (35.4%), followed by patients aged 20–39 years old

Discussion

In this study, we found the prevalence of CU in Taiwan to be about 0.69-0.79%, which is compatible with the previous reports [4], [5], [6]. An earlier study from Sweden found a point prevalence of CU of around 0.1% in the total population [18], but their definition of CU and study methods were different [4]. We used the NHIRD combined with consultation and prescription patterns to estimate the annual prevalence, which would be more accurate than questionnaire-based patient surveys. To our

Conclusion

We found the prevalence and annual incidence of CU in Taiwan to be about 0.69–0.79% and 0.50% respectively from 2010 to 2012. The female-to-male ratio among the CU patients was around 56:44. CU patients had higher prevalence of psychiatric disorders, inflammatory diseases, thyroid disorders, and rheumatic diseases.

Declaration of interests

Chia-Yu Chu is a clinical trial investigator of Novartis and has received travel support, consulting fees and payment for lectures from Novartis. Yung-Tsu Cho, Jhih-Hua Jiang, and Chao-Hsiun Tang declare no competing interest. Eve I-Chun Lin is an employee of Novartis (Taiwan) Co., Ltd., Taipei, Taiwan.

Funding source

The study was funded by Novartis (Taiwan) Co., Ltd., Taipei, Taiwan. However, Novartis (Taiwan) was not involved in any aspect of the planning, writing, or editing of this manuscript before or after its publication. The comments, views and conclusions set out in the manuscript represent those of the authors, independent of any input or influence from Novartis (Taiwan).

Ethical approval

The study was approved by the National Taiwan University Hospital Research Ethics Committee (201402045RINB).

Prior presentation

Global Urticaria Forum (GUF 2016), Berlin, November 29–30, 2016.

Acknowledgements

The study was funded by Novartis (Taiwan) Co., Ltd., Taipei, Taiwan. However, Novartis Taiwan was not involved in study design and conduct of the study; in the collection, management, analysis, and interpretation of the data; in the preparation, review, or approval of the report; and in the decision to submit the paper for publication. The comments, views and conclusions set out in the manuscript represent those of the authors, independent of any input or influence from Novartis Taiwan.

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