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INVESTIGATIVE REPORT 321 The Prevalence of Atopic Dermatitis and Chronic Spontaneous Urticaria are Associated with Parental Socioeconomic Status in Adolescents in China Yi XIAO 1–3 , Xiaoyan HUANG 1–3 , Danrong JING 1–3 , Yuzhou HUANG 1–3 , Liping CHEN 1–3 , Xingyu ZHANG 4 , Shuang ZHAO 1–3 , Mi ZHANG 1–3 , Zhongling LUO 1–3 , Juan SU 1–3 , Yehong KUANG 1–3 , Jie LI 1–3 , Wu ZHU 1–3 , Jianglin ZHANG 1–3 , Xiang CHEN 1–3 * and Minxue SHEN 1–3 * 1 Department of Dermatology, Xiangya Hospital, 2 Hunan Engineering Research Center of Skin Health and Disease, 3 Hunan Key Laboratory of Skin Cancer and Psoriasis, and 4 Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China The association of atopic dermatitis and chronic spon- taneous urticaria with socioeconomic status has been little studied. The aim of this study was to investigate the prevalence of skin diseases and their association with socioeconomic status in adolescents in China. A cross-sectional study was conducted at Central South University, Changsha, China. All newly enrolled stu- dents underwent dermatological examination and completed a survey. Socioeconomic status was mea- sured in terms of parental education level and inco- me. Two-level logistic regression models were used. A total of 8,226 students consented to participate. On dermatological examination, moderate to severe acne (10.2%) had the highest prevalence, followed by ch- ronic spontaneous urticaria (2.7%), atopic dermatitis (2.5%), and tinea (1.7%). Socioeconomic status was positively associated with the prevalence of chronic spontaneous urticaria (p trend  = 0.001) and atopic der- matitis (p trend  = 0.0094). Tinea was inversely associated with socioeconomic status (p trend  = 0.025). Higher pa- rental socioeconomic status was associated with hig- her risk of atopic dermatitis and chronic spontaneous urticaria, but lower risk of tinea. Key words: socioeconomic status; atopic dermatitis; chronic spontaneous urticaria; adolescent. Accepted Dec 6, 2018; E-published Dec 6, 2018 Acta Derm Venereol 2019; 99: 321–326. Corr: Xiang Chen and Minxue Shen, Department of Dermatology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, China 410008. E-mail: [email protected], [email protected] S kin diseases with atopic or allergic backgrounds, such as atopic dermatitis (AD), allergic contact der- matitis (ACD), and urticaria, have been an increasing focus of attention in recent years (1, 2). AD, a common chronic inflammatory skin disorder affecting one-fifth of the population in developed countries (3), is generally considered as an atopic disease, together with allergic rhinitis and asthma (4). Chronic spontaneous urticaria (CSU), manifesting as recurrent itchy wheals and/or angioedema for more than 6 weeks, affects 0.5–1% of the general population (5), and 0.1–0.3% of children (6). Although their aetiologies are complicated and ma- SIGNIFICANCE This is the first population-based epidemiological survey in Chinese adolescents regarding the prevalence of skin diseases. Health disparities exist in chronic spontaneous urticaria, atopic dermatitis, and tinea across adolescents’ parental socioeconomic status. A deeper understanding of the complex socioeconomic risk factors and mediators for skin diseases, especially allergic skin diseases, is needed. nifestations varied, AD and CSU, share many similar risk factors related to their increasing prevalence (2). Previously, epidemics of atopic diseases and skin al- lergies have been recognized more widely in western, developed, countries, compared with less-developed regions of East Asia, Europe and Africa (7–9). How­ ever, this global difference in prevalence has reduced, and public health concern is increasing in developing countries. Accumulated evidence has shown that these changing epidemics are associated with altered societal, economic and environmental determinants, in addition to genetic-susceptibility aetiology (10, 11). Socioeconomic status (SES), an important indicator of socioeconomic determinants, in studying health dispari- ties across different populations, is often measured ac- cording to income, education level and occupation at the individual level, and is determined by diverse economic contexts at the population level (12). A systematic review has reported wide variations in associations of SES with allergic rhinitis and asthma (13); however, the association of skin allergy, especially AD, with SES was consistent (4, 14). Globally, the prevalence of AD and CSU in deve- loped countries is higher than in developing countries in general (1). Furthermore, it has been reported that urban citizens with higher SES are more likely to experience al- lergies than those in deprived areas (14, 15). China, which has a typical transitional economy, has been undergoing rapid economic development, immense urbanization, and frequent socioeconomic mobility since the 1980s, which exert unmeasurable diverse influence on all sorts of disease epidemics. The prevalence of AD has been reported to have increased from 3.1% in 2002 to 12.9% in 2014 among selected children in China (16, 17). For This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica. doi: 10.2340/00015555-3104 Acta Derm Venereol 2019; 99: 321–326