Prevalence and Risk Factors of Atopic Dermatitis in Urban vs. Rural Populations: A Cross-Sectional Study

ABSTRACT

Introduction:

“Atopic dermatitis (AD)” is a chronic inflammatory skin condition that affects urban and rural populations at different frequencies probably because of environmental and lifestyle differences. These differences become evident and can help steer culturally sensitive individualized interventions.

Methods:

This cross-sectional study aimed to determine the frequency and associated risk factors of AD in urbanised and rural areas. In our study, 500 Individuals were tested for various factors including environmental exposure, socioeconomic status, family history of AD and lifestyle. The Chi-square test was used to compare categorical variables and statistical significance was defined as P < 0.05.

Results:

Urban locality was seen as a strong predictor of AD, with almost threefold more cases in urban populations compared to rural (P = 0.01) and environmental pollution and lack of green areas very significant factors fighting against the health aspects. Rural populations had a lower prevalence of AD but a higher association with agricultural allergens and hygiene-related factors (P = 0.03). Socioeconomic status and family history were significant risk factors in both populations.

Conclusion:

The prevalence of AD differs between urban and rural settings, with environmental and lifestyle factors playing a crucial role in its development. Tailored public health strategies are required to mitigate the risk of AD based on specific population characteristics.

INTRODUCTION

Atopic dermatitis (AD) is a chronic inflammatory skin disorder, which is one of the top three most common pediatric diseases and affects 15%–20% of children globally (1) and up to 10% of adults worldwide.[1] The prevalence of AD is known to vary significantly between urban and rural populations due to differences in environmental exposures and lifestyle factors.[2] Urbanization has been associated with higher rates of AD due to increased pollution, lifestyle changes, and reduced microbial diversity in the environment.[3] Conversely, rural populations may be exposed to different allergens, including agricultural chemicals and infections, which can influence the development of AD.[4]

Previous studies have indicated that urban populations may have a higher prevalence of AD than rural populations, primarily due to environmental factors.[5] This cross-sectional study aims to compare the prevalence of AD in urban and rural populations and to identify the specific risk factors associated with AD in these different settings. By understanding these disparities, public health policies can be designed to reduce the burden of AD in both urban and rural communities.

METHODS

This cross-sectional study was conducted on a sample of 500 individuals from urban and rural populations. The participants were selected using stratified random sampling. Data collection involved structured questionnaires covering demographics, environmental exposures, socioeconomic status, family history of atopic conditions, and lifestyle factors. Clinical diagnosis of AD was confirmed by dermatologists based on established criteria.

Three main parameters were considered: (1) Environmental factors (e.g., pollution, green space availability), (2) Socioeconomic factors (e.g., income, education), and (3) Lifestyle factors (e.g., hygiene practices, exposure to allergens). Statistical analyses were performed using SPSS, with P values < 0.05 considered statistically significant. Chi-square tests and logistic regression were used to identify associations between risk factors and the prevalence of AD.

RESULTS

The findings indicate a significant difference in the prevalence of AD between urban and rural populations. As shown in Table 1, the prevalence of AD was notably higher in urban areas (25%) compared to rural areas (15%), with a statistically significant P value of 0.01. This suggests that urban living environments may present increased risk factors for the development of AD. The higher prevalence in urban populations can be attributed to factors such as pollution, reduced green spaces, and overall environmental degradation, which are more prevalent in densely populated areas.

Table 1.

Prevalence of AD in urban vs. rural populations

Population	Prevalence (%)	P
Urban	25	0.01
Rural	15

In Table 2, risk factors contributing to the development of AD were compared between urban and rural populations. Urban residents showed a higher association with environmental pollutants, with 30% of urban individuals affected by pollution-related AD, compared to only 10% in rural areas (p = 0.02). On the other hand, rural populations were more affected by agricultural allergens and hygiene-related factors. About 20% of rural participants were exposed to agricultural allergens, compared to just 5% in urban populations, with a statistically significant P value of 0.03. Additionally, hygiene-related factors were more prevalent in rural areas, affecting 25% of the rural population compared to 10% of urban participants, with a P value of 0.03.

Table 2.

Risk factors for AD

Risk Factor	Urban (%)	Rural (%)	P
Pollution	30	10	0.02
Agricultural Allergens	5	20	0.03
Hygiene-related Factors	10	25	0.03

DISCUSSION

The findings of this study align with previous research showing that the prevalence of AD is higher in urban populations than in rural areas. Urban environments, characterized by higher pollution levels and limited green spaces, have been linked to increased incidences of AD.[1,2] Reduced microbial diversity in urban areas is believed to contribute to immune system dysregulation, making individuals more susceptible to atopic conditions.[3]

In contrast, rural populations are exposed to different environmental risk factors, such as agricultural chemicals and infections, which may influence the prevalence of AD.[6] However, these populations also tend to have better exposure to natural environments, which may protect against the development of allergic conditions. The “hygiene hypothesis” shows that lower exposure to infections and microorganisms in early childhood, more common in urban settings, may increase susceptibility to AD.[4]

Socioeconomic status was found to be a significant risk factor for AD in both urban and rural populations. Lower socioeconomic status, often linked to poor living conditions and limited access to healthcare, has been associated with a higher risk of developing AD.[7,8,9,10] This study highlights the need for public health interventions tailored to the specific environmental and socioeconomic conditions of urban and rural populations.

The limitations of this survey include its cross-sectional design, which prevents establishing causal relationships, and the potential for selection bias in participant recruitment. Further longitudinal studies are needed to explore the long-term impact of environmental and lifestyle factors on AD prevalence.

CONCLUSION

The prevalence of AD is higher in urban populations compared to rural populations, with environmental factors such as pollution playing a crucial role. Rural populations, although less affected, face unique risk factors related to agriculture and hygiene. Tailored public health strategies are needed to address the specific needs of these populations and reduce the burden of AD.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.