Urban Struggles: The Overlooked Burden of Atopic Dermatitis and Skin Infections in Indigenous Youth in Cities

Original Article: The burden of atopic dermatitis and bacterial skin infections among urban‐living Indigenous children and young people in high‐income countries: A systematic review

What are the key takeaways of this article?

Dermatology research in Indigenous communities is largely overlooked and underfunded. This contributes to a higher prevalence of common skin conditions like atopic dermatitis (AD), impetigo, and psoriasis in Canada. These issues are often exacerbated by environmental factors such as poor water quality and poverty, particularly in rural areas with limited healthcare access. Yet, even as more Indigenous people move to urban centers, the research remains insufficient. Despite the shared history of colonization and persistent health disparities in high-income countries, studies on AD and bacterial skin infections (BSIs) in urban Indigenous populations are still scarce.

A systematic review examined the burden of AD and BSI among urban-living Indigenous children and young people (CYP) in high-income countries (HIC). The review included 16 studies from 4 countries over 26 years, with 7 studies on AD and 9 studies on BSI. The studies used various methods including cross-sectional surveys, retrospective audits, and data linkage. For AD, the authors found that current and severe symptoms were more common in urban-living Indigenous CYP compared to their non-Indigenous peers. Among them, children had a higher prevalence of AD than adolescents. This may suggest undertreatment of AD in Indigenous populations, likely due to socioeconomic barriers to accessing primary and dermatological care. The higher prevalence of AD could also be driven by increased risk of secondary bacterial skin infections. For BSI, the review found that urban-living Indigenous CYP had a higher incidence of all measures of BSI compared to non-Indigenous peers. They were also over-represented for BSI compared to their proportion in the background population. The higher burden of BSI in urban Indigenous youth is likely influenced by social determinants of health like poverty and overcrowded living conditions.

The review has some limitations, including incomplete representation of all Indigenous populations in HIC due to a lack of records from the United States, Norway, Sweden, Finland, or Denmark. The BSI studies in particular had significant heterogeneity in study design, precluding use of a quality appraisal tool. Moreover, the review only identified BSI studies from Australia and New Zealand, limiting the generalizability of those findings.

In conclusion, this systematic review highlights a significant burden of both AD and BSI among urban-living Indigenous CYP in HIC. It revealed that AD and BSI rates are significantly higher among Indigenous CYP in urban areas compared to their non-Indigenous peers, with children showing higher AD prevalence than adolescents. The study highlights the disproportionate impact on Indigenous populations, despite incomplete representation in the available data.

The authors call for more research, particularly to better understand the impact in North American Indigenous populations where data was lacking. Collaborative, community-driven research will be important to develop sustainable prevention and treatment strategies for these common skin conditions in urban Indigenous youth.

Publication Date: October 30th, 2024

Reference: Ricciardo BM, Kessaris HL, Kumarasinghe P, Carapetis JR, Bowen AC. The burden of atopic dermatitis and bacterial skin infections among urban-living Indigenous children and young people in high-income countries: A systematic review. Pediatr Dermatol. 2023 Jan;40(1):35-43. doi: 10.1111/pde.15153. Epub 2022 Nov 9. PMID: 36349531; PMCID: PMC10946708.

Summary By: Megan Lowe