Atopic dermatitis, educational attainment and psychological functioning: a national cohort study

Summary Background Atopic dermatitis (AD) might adversely affect academic performance, possibly through influences on psychological functioning such as stress resilience. Objectives To investigate the association of atopic dermatitis with stress resilience, cognitive function and educational attainment. Methods We used data from a national cohort of men who underwent a military conscription examination at ages 17–20 years in Sweden between 1969 and 1976. All potential conscripts met a physician who assessed current or previous history of AD. Stress resilience was measured by a psychologist using a semistructured interview. The conscription assessment included a written cognitive function test. The highest level of education achieved was identified through record linkage. Results The study population included 234 715 men, 1673 (0·7%) of whom had a diagnosis of AD. AD was associated with a greater risk of low stress resilience [adjusted relative risk ratio (RRR) 1·60, 95% confidence interval (CI) 1·38–1·86]. AD was associated with higher cognitive function (β‐coefficient 0·15, 95% CI 0·05–0·24) and higher educational level (RRR 1·29, 95% CI 1·13–1·47). However, adjustment for socioeconomic characteristics of the family of origin attenuated the magnitude of the associations and eliminated the statistical significance (β‐coefficient 0·06, 95% CI −0·03 to 0·15; RRR 1·16, 95% CI 1·00–1·35). Conclusions Swedish men with AD had lower stress resilience in late adolescence but did not have lower cognitive function or poorer educational attainment. The lower stress resilience associated with AD is consistent with an increased risk of possible long‐term adverse health outcomes. What's already known about this topic? Atopic dermatitis can influence quality of life, but little is known about its possible impact on educational attainment. What does this study add? Atopic dermatitis was not associated with lower cognitive function or poorer academic attainment in this large general‐population‐based cohort study of men in Sweden. Men with atopic dermatitis had lower stress resilience in late adolescence, which has potential adverse implications for mental and physical health in subsequent adulthood. Respond to this article Linked Comment: Vittrup and Thyssen. Br J Dermatol 2019; 180: 452–453. Plain language summary available online