Understanding atopic dermatitis in Brazil

Health

Understanding atopic dermatitis in Brazil

December 05, 2018

Global

Elizabeth Sukkar
Elizabeth Sukkar

December 05, 2018

Global

Elizabeth Sukkar
Elizabeth Sukkar
Elizabeth Sukkar

Senior research manager

Elizabeth is a senior research manager in global health in the policy and insights team at Economist Impact. Prior to this, she was the managing editor and global healthcare editorial lead at Economist Intelligence Unit’s Thought Leadership division. She is the lead on global health projects that help build effective action to develop a sustainable health economy, with patients at the centre. She has led major research projects on universal healthcare, climate change and its impact on lung health, health literacy, digital health, cancer care, self-care, sin taxes, health financing and patient-centred care.  She is also the lead on The Economist Group’s World Cancer Initiative which has led to the development of new thinking in cancer care and is a key moderator at the Economist Impact Events’ such as the World Cancer Series, Future of Healthcare and Sustainability Summit. She is a member of the Royal Pharmaceutical Society, a fellow of the Royal Society for Public Health, and has two degrees: a bachelor of pharmacy degree from Monash University (Australia) and a Master of Science in International Health Policy from the London School of Economics (LSE). She has been a journalist and editor for more than 15 years, covering healthcare policy, R&D and science for medical journals and UK newspapers, including the British Medical Journal and the Guardian. Before joining The Economist Group, she was the deputy news editor at the Royal Pharmaceutical Society, where she ran the news and analysis desk and was often called to comment about healthcare issues on BBC radio. She also managed an international team of journalists when she was the world editor of Informa’s Scrip Intelligence, a global publication on pharmaceutical and healthcare policy, where she won the Informa Journalist of Year award. Before moving into journalism, Elizabeth worked as a pharmacist in community, hospital and health authority settings, and she maintains her pharmacist registration.

Read more from Elizabeth Sukkar
Contact

Brazil has a moderate lifetime prevalence of atopic dermatitis (AD) of around 14%.

Brazil’s National Healthcare System, known as the Unified Health System—Sistema Único de Saúde (SUS)—is a universal system and free to all citizens. It is provided by both private and government institutions, and while health policy is dictated at the federal level, elements of care and its execution are overseen by the individual states.

Brazil was assessed across 12 policy indicators on how well it manages atopic dermatitis (AD), also known as eczema, a chronic skin disease that can have psychosocial effects on patients and caregivers.

The Economist Intelligence Unit created an 8-country Atopic Dermatitis Scorecard, which contains policy indicators of importance to the management of the disease, including the provision of care and support for patients and caregivers (see below for the full Brazilian scorecard results).

Overall, Brazil performs moderately well compared with the other analysed countries. Brazil receives top scores for the currency of its population prevalence data, which were updated in 2008.2 According to that epidemiological data, 14% of the Brazilian population will have AD at some point in their life, a mid-range finding compared with the other countries reviewed (eg, Israel 9% and Australia 32%).

Studies of adult AD patients in Brazil, much like in other nations, have demonstrated a link between the disease and poor quality of life, both due to the disease severity and mental/emotional distress.3 AD is also among the most common dermatological diseases in Brazilian children.4 Among these paediatric patients, AD has a negative quality of life impact on patient and families, marked by itching and scratching, mood changes, treatment costs and sleep disturbance.5

Provision of care

According to the Economist Intelligence Unit scorecard findings, the country has 6,718 dermatologists for a population of 208m, totalling nearly 3 dermatologists per 100,000 people.6 Among the studied countries, this is on the higher end on a per-head basis. However, around 59% of dermatologists in Brazil are located in the south-east of the country, skewing the balance of regional access to treatment.7,8

The nation’s greatest relative strengths are in the specific recommendations for the use of multidisciplinary care. Multidisciplinary care services provide patients and carers with access to a number of healthcare professionals that share tools to better manage AD and corresponding quality- of-life issues.9

The Economist Intelligence Unit’s scoring was based on regional Latin American guidelines, which recommend that multidisciplinary care be considered. And unlike any other guidelines analysed by The Economist Intelligence Unit, Latin America’s includes recommendations as to what the team make-up should include: dermatologists, paediatricians, allergists and psychologists.10 Brazil also has two joint position papers on the diagnosis and treatment of AD from the Brazilian Association of Allergy and Immunology and the Brazilian Society of Pediatrics.11,12

Brazil also performs strongly in its recommendations around psychological and emotional support for patients and carers. Brazil is one of three analysed countries found to use guidelines that recommend one or more specific psychological interventions and a referral process for that care. Specifically, the Latin American guidelines used by Brazil recommend an annual assessment for psychology in all patients with severe symptoms.10

Patient groups are helping to fill the gaps. In one Brazilian study, paediatric AD patients and their families attended a support group and afterwards reported a better knowledge of the anxieties and social difficulties of AD patients, as well as the correct use of medication to help patients. The results were also used as guidance for professionals on more effective ways to counsel patients and families.13

Monitoring and measuring

When it comes to monitoring and measuring AD, Brazil has a top score for having validated severity measure (eg, mild or severe),10 however, it is limited in the fact that it does not use quality-of-life measures—for which we did not rank this indicator high.10 This is significant because beyond the physical impact of AD (dry, itchy skin) the disease’s most significant effects are a complex array of quality-of-life issues that range from social distancing, low self-esteem and depression, to possible loss of jobs and education opportunities.14,15,16,17,18,19

In addition, the guidelines do not mention a need to assess the wider impacts of AD on families and carers, which deal with the impacts on a day-to-day basis.20 They often experience anxiety, poor sleep, time off work, and a lower family quality of life.18,20,21 Yet many countries do not formally account for these issues in their assessment of AD impacts. In the Latin American guidelines, family are mentioned when it comes to integrated education and assessing family history, but not when regarding the impact.10

Full scorecard results for Brazil are available in the downloadable article

REFERENCES

1 The Economist Intelligence Unit. A misunderstood skin disease: mapping the policy response to atopic dermatitis. October 2018. This report contains the Atopic Dermatitis Scorecard; full explanation of the scores are available at the end of the article. 
2 Deckers IAG et al. Investigating international time trends in the incidence and prevalence of atopic eczema 1990–2010: A systematic review of epidemiological studies. PLoS ONE. 2012;7(7):e39803.
3 Coghi S et al. Quality of life is severely compromised in adult patients with atopic dermatitis in Brazil, especially due to mental components. Clinics (Sao Paulo). 2017; 62(3):235-42.
4 Bertanha F et al. Profile of patients admitted to a triage dermatology clinic at a tertiary hospital in São Paulo, Brazil. Anais Brasileiros De Dermatologia Journal. 2016 May-Jun; 91(3): 318–325.
5 Tassiana M et al. Quality of life in pediatric patients with atopic dermatitis. Jornal de Pediatria (Rio J). 2009;85(5):415-420.
6 Schmitt JV et al. Distribution of Brazilian dermatologists according to geographic location, population and HDI of municipalities: an ecological study. An Bras Dermatol. 2014 Nov-Dec; 89(6): 1013–1015.
7 Scheffer M. Demografia Médica no Brasil 2018. São Paulo, SP: FMUSP, CFM, Bremesp, 2018 (page 110). ISBN: 978-85- 87077-55-4
8 Arantes L et al. Contribution and challenges of the Family Health Strategy for the Family on Primary Health Attention in Brasil. Ciência & Saúde Coletiva. 2016; 21 (5)
9 Spielman SC et al. A review of multidisciplinary interventions in atopic dermatitis. Journal of Clinical Medicine. 2015;4(5):1156-1170.
10 Sánchez J et al. Atopic dermatitis guideline. Position paper from the Latin American Society of Allergy, Asthma and Immunology. Revista Alergia México. 2014; Jul-Sep;61(3):178-211.
11 Antunes A et al. Updated practical guide on atopic dermatitis – Part I: etiopathogenesis, clinical features, and diagnosis. Joint position paper of the Brazilian Association of Allergy and Immunology and the Brazilian Society of Pediatrics. Arq Asma Alerg Imunol. 2017; 1(2): 131-56.
12 Carvalho VO et al. Updated practical guide on atopic dermatitis – Part II: treatment approach. Joint position paper of the Brazilian Association of Allergy and Immunology and the Brazilian Society of Pediatrics. Arq Asma Alerg Imunol. 2017; 1(2): 157-82.
13 Cestari T et al. The role of support groups in the treatment of atopic dermatitis. Journal of the American Academy of Dermatology. 2015; 52 (3):74
14 Gochnauer H et al. The psychosocial impact of atopic dermatitis. Advances In Experimental Medicine And Biology. 2017;1027:57-69.
15 Allergy UK and Sanofi Genzyme. Seeing Red: Getting under the skin of adult severe eczema. 2017.
16 Drucker AM et al. The burden of atopic dermatitis: Summary of a Report for the National Eczema Association. Journal of Investigative Dermatology. 2017; 137(1):26-30.
17 Drucker AM et al. Audit: burden of eczema: the burden of disease of atopic dermatitis. San Rafael, CA: National Eczema Association, 2015. Available from: https://national eczema.org/ wp-content/uploads/2016/06/NEA-report- final12_30_2015.pdf.
18 Zuberbier T et al. Patient perspectives on the management of atopic dermatitis. Journal of Allergy and Clinical Immunology. 2006; 118(1):226-32.
19 Eczema Society of Canada. Atopic Dermatitis Quality of Life Report: moderate to severe disease 2016/2017 survey results.
20 Marciniak J et al. Quality of life of parents of children with atopic dermatitis. Acta Dermato-Venereologica. 2017; 97: 711–714.
21 Smith SD et al. Corticosteroid phobia and other confounders in the treatment of childhood atopic dermatitis explored using parent focus groups. Australasian Journal of Dermatology. 2010; 51(3):168-74.
22 Jang HJ et al. Family quality of life among families of children with atopic dermatitis. Asia Pacific Allergy. 2016;6(4):213- 219.

More from this series

Health

white paper

A misunderstood skin disease: Mapping the policy response to atopic dermatitis

Multidisciplinary care for atopic dermatitis can benefit patients of AD as

Read more
Health

article

Understanding atopic dermatitis in Australia

Australia scores in the middle of the scorecard countries for

Read more
Health

article

Understanding atopic dermatitis in Italy

The Economist Intelligence Unit analysed the country’s specific policy

Read more

17105

Related content

Health

Value-based healthcare in Sweden: Reaching the next level

The need to get better value from healthcare investment has never been more important as ageing populations and increasing numbers of people with multiple chronic conditions force governments to make limited financial resources go further.

These pressures, along with a greater focus on patient-centred care, have raised the profile of VBHC, especially in European healthcare systems. Sweden, with its highly comprehensive and egalitarian healthcare system, has been a leader in implementing VBHC from the beginning, a fact that was underscored in a 2016 global assessment of VBHC published by The Economist Intelligence Unit. 

This paper looks at the ways in which Sweden has implemented VBHC, the areas in which it has faced obstacles and the lessons that it can teach other countries and health systems looking to improve the value of their own healthcare investments.

Read more

Health

Breast cancer patients and survivors in the Asia-Pacific workforce

With more older women also working, how will the rising trend of breast cancer survivorship manifest in workplace policies, practices and culture? What challenges do breast cancer survivors face when trying to reintegrate into the workforce, or to continue working during treatment? How can governments, companies and society at large play a constructive role?

This series of reports looks at the situation for breast cancer survivors in Australia, New Zealand and South Korea. It finds that while progress has been made, more needs to be done, particularly in South Korea, where public stigma around cancer remains high.
Read more

Health

The Cost of Silence

Cardiovascular diseases levy a substantial financial toll on individuals, their households and the public finances. These include the costs of hospital treatment, long-term disease management and recurring incidence of heart attacks and stroke. They also include the costs of functional impairment and knock-on costs as families may lose breadwinners or have to withdraw other family members from the workforce to care for a CVD patient. Governments also lose tax revenue due to early retirement and mortality, and can be forced to reallocate public finances from other budgets to maintain an accessible healthcare system in the face of rising costs.

As such, there is a need for more awareness of the ways in which people should actively work to reduce their CVD risk. There is also a need for more primary and secondary preventative support from health agencies, policymakers and nongovernmental groups.

To inform the decisions and strategies of these stakeholders, The Economist Intelligence Unit and EIU Healthcare, its healthcare subsidiary, have conducted a study of the prevalence and costs of the top four modifiable risk factors that contribute to CVDs across the Asian markets of China, Australia, Hong Kong, Japan, Singapore, South Korea, Taiwan and Thailand.

Download the report to learn more.

Read more

Enjoy in-depth insights and expert analysis - subscribe to our Perspectives newsletter, delivered every week

Copyright © The Economist Newspaper Limited 2024. All rights reserved.