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Incidence of Asthma, Atopic Dermatitis, and Allergic Rhinitis in Korean Adults before and during the COVID-19 Pandemic Using Data from the Korea National Health and Nutrition Examination Survey
By Hyo Geun Choi 1, †, So Young Kim 2, †, Yeon-Hee Joo 3, 4, Hyun-Jin Cho 4, 5, Sang-Wook Kim 4, 5 and Yung Jin Jeon 4, 5, *
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The prevalence of allergic diseases has been increasing globally prior to COVID-19. The pandemic resulted in changes in lifestyle and personal habits such as universal mask-wearing and social distancing. However, there is insufficient information on the impact of the COVID-19 pandemic on the prevalence of allergic conditions such as asthma, atopic dermatitis, and allergic rhinitis. We analyzed the incidence rate for self-reported and doctor-diagnosed cases of allergic diseases of asthma, atopic dermatitis, and allergic rhinitis. A total of 15, 469 subjects were registered from a national cohort dataset of the National Health and Nutrition Examination Survey. Using multiple logistic regression analysis, we calculated the adjusted odds ratio (OR) for each disease in 2020 compared to 2019. Subgroup analyses were performed according to age and sex. There were no statistically significant differences between the incidence of doctor-diagnosed and current allergic diseases in 2019 and 2020 (asthma, p = 0.667 and p = 0.268; atopic dermatitis, p = 0.268 and p = 0.973; allergic rhinitis, p = 0.691 and p = 0.942, respectively), and subgroup analysis showed consistent results. Among the Korean population from 2019 to 2020, the incidence of the allergic diseases asthma, atopic dermatitis, and allergic rhinitis did not decrease as expected.
A new strain of human coronavirus emerged in 2019 and caused an epidemic and has been designated by the International Committee on Taxonomy of Viruses (ICTV) as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) [1]. The disease was named “Coronavirus Infectious Disease 2019 (COVID-19)” by the World Health Organization (WHO). Since the first outbreak in Wuhan, China, in December 2019, COVID-19 spread aggressively around the world [2]. On 20 January 2020, the Republic of Korea reported its first case of COVID-19. The Korea Centers for Disease Control and Prevention (KCDC) reported a rapid increase in continuous transmission of COVID-19 on 19 February 2020 [3]. The WHO proclaimed a COVID-19 pandemic on 11 March 2020. Lifestyles changed dramatically to prevent the spread of epidemic infections and have remained affected to the present [4]. Official directives such as increased hand washing, mask-wearing, social distancing, and working from home are not only affecting the dispersion of COVID-19, but also the spread of other transmittable diseases.

Atopic diseases tend to be an exaggerated immunoglobulin E-mediated immune response in response to the foreign allergen [5]. Patients with atopic traits usually present with one or more symptoms of the following disorders: asthma, atopic dermatitis, and allergic rhinitis. In recent decades, the prevalence of allergic diseases has been steadily increasing, and it currently affects about 20% of the population in developed countries [6, 7]. Allergic diseases can develop at a relatively young age and reduce the quality of life [8]. Allergic diseases are common chronic and recurrent inflammatory diseases. Continuous management is required to treat allergic diseases, and the socioeconomic burden is increasing worldwide. In recent decades, the prevalence of allergic diseases has raised rapidly worldwide, especially in low- and middle-income countries [9, 10]. However, evidence supporting such trends in asthma, atopic dermatitis, and allergic rhinitis in the Republic of Korea is controversial. Some previous studies have reported that the prevalence has increased, and others have reported that this prevalence has decreased [11, 12, 13, 14]. In a recent study using large population data distributed by the National Health and Nutrition Examination Survey (KNHANES), the 10-year trend in asthma prevalence reported from 2008 to 2017 was stable [6].
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Social restrictions including universal masking requirements, social distancing, and national lockdowns were intended to reduce the burden of COVID-19 mortality and morbidity. Additionally, these social limitations have been associated with a reduction in non–SARS-CoV-2 infections such as seasonal influenza, other respiratory infections, and foodborne infectious diseases [15, 16, 17, 18]. Individuals had to adapt by changing their daily routines. The quarantine has disrupted lifestyle behaviors, including those associated with work, education, physical exercise, sleep, and food consumption [19, 20, 21, 22]. To prevent viral spread, public places such as offices, schools, gyms, and restaurants have closed or have severely limited occupancy. However, there is insufficient information concerning the influence of the COVID-19 pandemic on the prevalence or severity of allergic diseases of asthma, atopic dermatitis, and allergic rhinitis. In this study, we examined and compared the epidemiologic characteristics and the proportions of ‘doctor-diagnosed’ and ‘currently diagnosed’ allergic diseases to evaluate the incidence of allergic diseases from 2019 (before COVID-19 appearance) and 2020 (during the COVID-19 epidemic).
The KNHANES (https://knhanes.kdca.go.kr/knhanes/main.do, accessed on 31 August 2022) was conducted by the KCDC in the interest of public welfare. Institutional Review Board (IRB) review and authorization requirements for the present study were waived by the KCDC. This study meets the standards described in paragraph 2 and subparagraph 1 of the Bioethics and Safety Act and paragraph 1, subparagraph 1 of the Enforcement Rule of the Bioethics and Safety articles. All KNHANES data analyses were performed under the guidelines provided by the IRB of the KCDC. The feasibility, understanding, and reliability of each questionnaire were surveyed by the KCDC to authenticate the applicability of the questionnaires.

These repeated cross-sections used the KNHANES database from the national medical insurance provider. Database-associated statistical procedures were based on constructed sampling and corrected weighted values. The database was assembled by the KCDC. A panel chooses a yearly sample of 25 households from 192 account districts to create a database that reflects the entire Korean population. Statisticians who conducted post-stratification analyses weighted the sample to reflect extreme values and non-response rates. Data from the eighth KNHANES performed between 2019 and 2020 were analyzed. Because the first positive case of COVID-19 in the Republic of Korea was identified on 20 January 2020, a comparison of data from 2019 and 2020 was deemed appropriate. This study did not follow enrolled participants from 2019 to 2020, but analyzed data from newly-extracted individuals each year.
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The KNHANES website (https://knhanes.kdca.go.kr/knhanes/main.do, accessed on 31 August 2022) describes the details of the sampling procedures. Of the total of 15, 469 participants (8110 in 2019; 7359 in 2020), exclusions from the study included participants younger than 19 (n = 2730), those missing body mass index (BMI) data (n = 653), those missing income data (n = 59), and those without a sleep time record (n = 13). Remaining for inclusion in the study were 12, 014 participants (6218 from 2019 and 5796 from 2020) older than 19 years (Figure 1). We investigated the prevalence of asthma, atopic dermatitis, and allergic rhinitis between 2019 and 2020 based on self-reporting.
In 2019 and 2020 surveys, we selected adult participants meeting inclusion and exclusion criteria who represented the entire population of the Republic of Korea. We did not follow the 2019 participants; 2020 participants were newly-selected from the entire Korean population.

Data were acquired on medical histories of asthma, atopic dermatitis, and allergic rhinitis. The relevant survey questions were: “Have you been diagnosed with asthma by a doctor within 12 months?”. If yes, the condition was classified as ‘doctor-diagnosed asthma.’ Additionally, the participants were asked “Are you currently being treated for asthma?” If yes, the condition was classified as ‘current asthma.’ Atopic dermatitis and allergic rhinitis were surveyed on the same questionnaire [23].
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Income was recalculated as the distribution of total household income value by the square root of the total number of family members [24]. We classified employment status as either unemployed or employed. We divided educational status as college or higher, high school, junior high school, elementary school or lower, or unknown. We surveyed and classified house type as detached house, condominium, townhouse, or others. We classified
Social restrictions including universal masking requirements, social distancing, and national lockdowns were intended to reduce the burden of COVID-19 mortality and morbidity. Additionally, these social limitations have been associated with a reduction in non–SARS-CoV-2 infections such as seasonal influenza, other respiratory infections, and foodborne infectious diseases [15, 16, 17, 18]. Individuals had to adapt by changing their daily routines. The quarantine has disrupted lifestyle behaviors, including those associated with work, education, physical exercise, sleep, and food consumption [19, 20, 21, 22]. To prevent viral spread, public places such as offices, schools, gyms, and restaurants have closed or have severely limited occupancy. However, there is insufficient information concerning the influence of the COVID-19 pandemic on the prevalence or severity of allergic diseases of asthma, atopic dermatitis, and allergic rhinitis. In this study, we examined and compared the epidemiologic characteristics and the proportions of ‘doctor-diagnosed’ and ‘currently diagnosed’ allergic diseases to evaluate the incidence of allergic diseases from 2019 (before COVID-19 appearance) and 2020 (during the COVID-19 epidemic).
The KNHANES (https://knhanes.kdca.go.kr/knhanes/main.do, accessed on 31 August 2022) was conducted by the KCDC in the interest of public welfare. Institutional Review Board (IRB) review and authorization requirements for the present study were waived by the KCDC. This study meets the standards described in paragraph 2 and subparagraph 1 of the Bioethics and Safety Act and paragraph 1, subparagraph 1 of the Enforcement Rule of the Bioethics and Safety articles. All KNHANES data analyses were performed under the guidelines provided by the IRB of the KCDC. The feasibility, understanding, and reliability of each questionnaire were surveyed by the KCDC to authenticate the applicability of the questionnaires.

These repeated cross-sections used the KNHANES database from the national medical insurance provider. Database-associated statistical procedures were based on constructed sampling and corrected weighted values. The database was assembled by the KCDC. A panel chooses a yearly sample of 25 households from 192 account districts to create a database that reflects the entire Korean population. Statisticians who conducted post-stratification analyses weighted the sample to reflect extreme values and non-response rates. Data from the eighth KNHANES performed between 2019 and 2020 were analyzed. Because the first positive case of COVID-19 in the Republic of Korea was identified on 20 January 2020, a comparison of data from 2019 and 2020 was deemed appropriate. This study did not follow enrolled participants from 2019 to 2020, but analyzed data from newly-extracted individuals each year.
Working Patterns Of Medical Staff In The Future Hospital
The KNHANES website (https://knhanes.kdca.go.kr/knhanes/main.do, accessed on 31 August 2022) describes the details of the sampling procedures. Of the total of 15, 469 participants (8110 in 2019; 7359 in 2020), exclusions from the study included participants younger than 19 (n = 2730), those missing body mass index (BMI) data (n = 653), those missing income data (n = 59), and those without a sleep time record (n = 13). Remaining for inclusion in the study were 12, 014 participants (6218 from 2019 and 5796 from 2020) older than 19 years (Figure 1). We investigated the prevalence of asthma, atopic dermatitis, and allergic rhinitis between 2019 and 2020 based on self-reporting.
In 2019 and 2020 surveys, we selected adult participants meeting inclusion and exclusion criteria who represented the entire population of the Republic of Korea. We did not follow the 2019 participants; 2020 participants were newly-selected from the entire Korean population.

Data were acquired on medical histories of asthma, atopic dermatitis, and allergic rhinitis. The relevant survey questions were: “Have you been diagnosed with asthma by a doctor within 12 months?”. If yes, the condition was classified as ‘doctor-diagnosed asthma.’ Additionally, the participants were asked “Are you currently being treated for asthma?” If yes, the condition was classified as ‘current asthma.’ Atopic dermatitis and allergic rhinitis were surveyed on the same questionnaire [23].
Full Article: Newly Qualified Doctors' Perceptions Of Informal Learning From Nurses: Implications For Interprofessional Education And Practice
Income was recalculated as the distribution of total household income value by the square root of the total number of family members [24]. We classified employment status as either unemployed or employed. We divided educational status as college or higher, high school, junior high school, elementary school or lower, or unknown. We surveyed and classified house type as detached house, condominium, townhouse, or others. We classified
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