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| Title: | Fracture risks in patients with atopic dermatitis: A nationwide matched cohort study—reply |
| Authors: | Lin, TL;Wu, CY;Chen, YJ |
| Contributors: | National Institute of Cancer Research |
| Abstract: | We thank the respondents to our article 1 for their insightful comments. Although we have matched subjects in both cohorts by age, sex, comorbidities, and index date, Lin et al 2 indicate a lack of adjustment for co-medication status, including the use of corticosteroids and disease-modifying antirheumatic drugs (DMARDs), in the propensity score. We agree that these medications are important confounders on fracture. We therefore had conducted multivariate analysis in the published article by adjustment for corticosteroids, DMARDs, and phototherapy. Moderate to severe atopic dermatitis (AD) was found to be associated with fractures, independent of exposure to these treatments. Further sensitivity analyses stratified by pharmacologic treatment and phototherapy revealed consistent results. Lin et al 2 express concerns at the accuracy of diagnoses of AD and fracture in Taiwan’s National Health Insurance Research Database. In fact, the database has been validated 3 and used extensively in epidemiologic studies. 4,5 To minimize misclassification biases, we included only AD and fracture coded in outpatient data sets at least 3 times or in inpatient data sets at least once. In addition, the diagnosis of AD should be established by a dermatologist, pediatrician, or rheumatol ogist. Such definition of AD and fracture has also been adopted in numerous studies published in leading international journals. 4,6-8 Osteoporosis is a risk factor for fracture. Because asymptomatic or early osteoporosis might be unnoticed, osteoporosis might be underestimated in claim-based database. The underestimates of osteoporosis could be similar in both cohorts. We assumed that the effect of underestimates on fracture risk is similar in both cohorts. The fair accessibility to medical treatment and low out-of-pocket payment in Taiwan brought Taiwanese to seek medical care when feeling discomfort. This unique health care-seeking behavior helps guard against underdiagnosis of fracture. We therefore believe that our selection criteria are solid and robust. |
| Date: | 2022-02 |
| Relation: | Annals of Allergy, Asthma and Immunology. 2022 Feb;128(2):Article number 231. |
| Link to: | http://dx.doi.org/10.1016/j.anai.2021.11.001 |
| JIF/Ranking 2023: | http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=NHRI&SrcApp=NHRI_IR&KeyISSN=1081-1206&DestApp=IC2JCR |
| Cited Times(WOS): | https://www.webofscience.com/wos/woscc/full-record/WOS:000756154700026 |
| Cited Times(Scopus): | https://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=85123729992 |
| Appears in Collections: | [其他] 期刊論文
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| SCP85123729992.pdf | | 96Kb | Adobe PDF | 142 | View/Open |
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