Perceived stress links income loss and urticaria activity during the COVID-19 pandemic
Perceived stress links income loss and urticaria activity during the COVID-19 pandemic
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COVID-19 大流行期间，感知压力与收入损失和荨麻疹活动有关
DOI：
10.1016/j.anai.2020.08.019
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发表时间：
2020
影响因子：
5.9
通讯作者：
Jie Li
中科院分区：
文献类型：
--
作者：
Minxue Shen;Yangjian Xiao;Yan Yuan;Xiang Chen;Jie Li
2019冠状病毒病（COVID-19）大流行对个人及社会层面的健康及经济造成重大不利影响。据估计，全球失业率可能因疫情而由4. 9%上升至5. 6%。1几十年的研究积累了失业对与贫困有关的健康结果和精神疾病（如压力和焦虑）的不利影响的证据。[2]有趣的是，已经确定过敏性疾病与较高的社会经济地位（SES）有关。3然而，不太清楚的是，不利的生活事件，如收入损失，是否会引发或增强过敏的活动。很少有流行病学研究已经解决了这个问题，但最近的一项综述总结了神经免疫皮肤串扰作为一种机制，连接心理压力和荨麻疹。4 COVID-19的爆发创造了一个独特的准实验，并提供了研究这种关联的机会。我们假设收入损失可能会通过精神压力增加荨麻疹活动;因此，我们在2020年2月27日至2020年3月11日期间对中国成年患者进行了一项基于社交媒体的调查。这是通过向2个微信群分发链接完成的，该微信群由中华人民共和国长沙湘雅医院皮肤科诊断为荨麻疹的980名患者组成。收入损失被问到一个问题，“自从COVID-19疫情以来，你的月收入有什么变化吗？”并分类为完全损失、减少和未受影响。主要结果是慢性荨麻疹的活动性，由荨麻疹活动性评分（UAS）确定。单独分析过去7天内风团和瘙痒的严重程度和频率，将每周超过1天的中度至重度风团或瘙痒或风团或瘙痒频率定义为结局（二元）。次要结局包括感知压力（视觉模拟量表）、焦虑症状（2项广泛性焦虑症）和抑郁（患者健康问卷-2）。在视觉模拟量表、2项广泛性焦虑症和患者健康问卷-2中，压力的临界值分别为7、3和3。5，6调整的协变量包括性别、年龄、教育程度、收入、疾病史和大流行期间的户外活动限制。多变量逻辑回归用于估计与调整的关联。效应量表示为调整后的比值比（aOR）和95%置信区间。压力的中介作用进行了测试和估计使用的bootstrapping方法。P值小于。05被认为具有统计学显著性。用R 3.5版对数据进行分析。2.共回收有效问卷234份，其中成人慢性荨麻疹患者182份。患者的平均年龄为33.7 ± 10.9岁，55.5%为女性。只有68人（37.3%）报告收入未受影响，54人（29.7%）报告收入减少，60人（33.0%）报告收入完全损失。通过比较参与者的特征，收入损失与性别、教育水平、收入和户外活动显著相关（所有P值<. 05），并在多变量模型中进一步调整。一般而言，就风团和瘙痒的严重程度和频率而言，收入损失与荨麻疹活动呈剂量依赖性相关（表1）。然而，在对协变量进行调整后，仅在风团频率中观察到显著相关（收入减少的aOR为2.45）。
The pandemic of coronavirus disease 2019 (COVID-19) has caused substantially adverse effects on health and economy at both individual and societal levels. It was estimated that the worldwide unemployment rate might increase from 4.9% to 5.6% owing to the pandemic. 1 Decades of research have accumulated evidence on the adverse impacts of unemployment on poverty-related health outcomes and mental illness, such as stress and anxiety. 2 Interestingly, it has been well established that allergic diseases are associated with higher socioeconomic status (SES). 3 However, it is less known whether adverse life events, such as loss of income, would trigger or enhance the activity of allergies. Few epidemiologic studies have addressed this question, but a recent review summarized the neuroimmuno-cutaneous crosstalk as a mechanism that links psychological stress and urticaria. 4 The outbreak of COVID-19 uniquely creates a quasi-experiment and provides an opportunity to study this association. We assumed that the income loss could increase urticaria activity through mental stress; hence, we conducted a social mediaebased investigation in adult Chinese patients between February 27, 2020, and March 11, 2020. This was done by distributing a link to 2 WeChat groups consisting of 980 patients who were diagnosed as having urticaria in the Department of Dermatology, Xiangya Hospital, Changsha, People’s Republic of China. Loss of income was inquired by a question,“Since the epidemic of COVID-19, is there any change in your monthly income?” and categorized as complete loss, reduced, and unaffected. The primary outcome was the activity of chronic urticaria, determined by the urticaria activity score (UAS). The severities and frequencies of wheals and itch during the past 7 days were analyzed separately, and moderate-to-intense wheals or itch or frequencies of wheals or itch for more than 1 day per week were defined as the outcomes (binary). The secondary outcomes included perceived stress (visual analogue scale), symptoms of anxiety (2-item generalized anxiety disorder), and depression (Patient Health Questionnaire-2). The cutoffs were 7, 3, and 3 for stress in the visual analogue scale, 2-item generalized anxiety disorder, and Patient Health Questionnaire-2, respectively. 5, 6 Covariates for adjustments included sex, age, education, income, history of disease, and outdoor activity restriction during the pandemic. Multivariable logistic regression was used to estimate the associations with adjustments. The effect size was presented as adjusted odds ratio (aOR) and 95% confidence interval. The mediation effect of stress was tested and estimated using the bootstrapping method. A P value of less than. 05 was considered statistically significant. The data were analyzed with R version 3.5. 2. A total of 234 valid questionnaires were collected, and 182 of them were adult patients with chronic urticaria. The mean age of the patients was 33.7 plus or minus 10.9, and 55.5% were women. Only 68 (37.3%) reported unaffected income, whereas 54 (29.7%) reported reduced income, and 60 (33.0%) reported complete loss of income. By comparing the participants’ characteristics, income loss was significantly associated with sex, educational level, income, and outdoor activity (all P values<. 05), which were further adjusted in multivariable models. In general, loss of income was dose-dependently associated with urticaria activity with respect to the severities and frequencies of wheals and itch (Table 1). However, after adjustments for covariates, significant associations were only observed in the frequency of wheals (aOR ¼ 2.45 for reduced income …