Atopic dermatitis in US adults: from population to healthcare utilization.

Publication date: Available online 14 January 2019

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Jonathan I. Silverberg, Joel M. Gelfand, David J. Margolis, Mark Boguniewicz, Luz Fonacier, Mitchell H. Grayson, Peck Y. Ong, Zelma Chiesa Fuxench, Eric L. Simpson

Abstract

Background

Little is known about the predictors of healthcare utilization among US adults with atopic dermatitis (AD).

Objectives

To determine the proportion and predictors of utilization in outpatient, urgent care, emergency department (ED) and hospital settings in US adults with AD.

Methods

A cross-sectional, population-based study of 3,495 adults was performed. AD was determined using modified United Kingdom Working Party (UKWP) Criteria. AD severity was assessed using Patient-Oriented Eczema Measure (POEM), Patient-Oriented Scoring AD (PO-SCORAD) and Numeric rating scale (NRS)-itch. Weighted frequency and prevalence (95% confidence intervals [CI]) of utilization were determined.

Results

Overall, 10.42% (95% CI: 8.55-12.28%; weighted frequency: 25,844,871) reported a diagnosis of AD or eczema, 7.39% (5.81-8.97%; 18,324,869) met UKWP criteria, and 3.56% (2.40-4.72%; 8,830,095) met both. 31.8% (2,711,690) had a severe score for POEM, PO-SCORAD and/or NRS-itch, with 4.0% (337,586) having severe scores for all three. Outpatient utilization for AD was low for mild disease (29.3-34.7%) and increased by severity (moderate: 36.2-49.8%; severe: 50.6-86.6%). Timeliness of appointments, expenses and insurance coverage were also predictors of outpatient utilization. Severe POEM, PO-SCORAD and/or NRS-itch were associated with being uninsured, not having full prescription coverage, AD prescriptions being denied by insurers, and costs of AD medications being problematic. One in 10 adults with AD had ≥1 urgent care, ED or hospital visit in the past year. Urgent care or ED visits were significantly more common among blacks and Hispanics, lower household income, lower education level, and AD prescriptions being denied by their insurance company.

Conclusion

Adults with AD had low rates of outpatient and high rates of urgent care, ED and hospital visits. The major predictor of outpatient utilization for AD care was AD severity. Racial/ethnic, socio-economic and/or healthcare disparities reduce outpatient utilization and increase urgent, ED and hospital utilization.

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