Abstract
Background: Little is known about the predictors of health care utilization among US adults with atopic dermatitis (AD). Objective: 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 3495 adults was performed. AD was determined using modified United Kingdom Working Party criteria. AD severity was assessed using the Patient-Oriented Eczema Measure (POEM), the Patient-Oriented Scoring AD (PO-SCORAD), and the Numeric Rating Scale (NRS)-itch. Weighted frequency and prevalence (95% CIs) 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% (95% CI, 5.81%-8.97%; weighted frequency, 18,324,869) met United Kingdom Working Party criteria, and 3.56% (95% CI, 2.40%-4.72%; weighted frequency, 8,830,095) met both. A total of 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 3. 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 or more urgent care, ED, or hospital visit in the past year. Urgent care or ED visits were significantly more common among blacks and Hispanics, those with lower household income, those with lower education level, and those with AD prescriptions being denied by the insurance company. Conclusions: 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, socioeconomic, and/or health care disparities reduce outpatient utilization and increase urgent care, ED, and hospital utilization.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1524-1532.e2 |
| Journal | Journal of Allergy and Clinical Immunology: In Practice |
| Volume | 7 |
| Issue number | 5 |
| DOIs | |
| State | Published - May 1 2019 |
Funding
Atopic Dermatitis in America Study is an independent research project of the Asthma and Allergy Foundation of America in partnership with the National Eczema Association and sponsored by Sanofi Genzyme and Regeneron.Conflicts of interest: J. I. Silverberg served as a consultant and/or advisory board member for Abbvie, Asana, Eli Lilly, Galderma, GlaxoSmithKline, Glenmark, Kiniksa, Leo, Menlo, Pfizer, Regeneron-Sanofi, Realm, and Roivant, receiving honoraria; served as a speaker for Regeneron-Sanofi; received research grants from GlaxoSmithKline and Regeneron-Sanofi; and is supported by the Dermatology Foundation. J. M. Gelfand served as a consultant for BMS, Boehringer Ingelheim, GlaxoSmithKline, Janssen Biologics, Menlo Therapeutics, Novartis Corp, Regeneron, Dr Reddy's Labs, UCB (DSMB), Sanofi, and Pfizer Inc, receiving honoraria; receives research grants (to the trustees of the University of Pennsylvania) from Abbvie, Janssen, Novartis, Sanofi, Celgene, Ortho Dermatologics, and Pfizer; received payment for continuing medical education work related to psoriasis that was supported indirectly by Lilly and Ortho Dermatologics; is a co-patent holder of resiquimod for treatment of cutaneous T-cell lymphoma; and is a Deputy Editor for the Journal of Investigative Dermatology, receiving honoraria from the Society for Investigative Dermatology. Z. Chiesa Fuxench has served as a consultant for the National Eczema Association and the Asthma and Allergy Foundation, receiving honoraria, and receives or has received research grants (to the trustees of the University of Pennsylvania) from Regeneron, Sanofi, Tioga, Vanda and Menlo Pharmaceuticals, and Realm Therapeutics for work in atopic dermatitis; and has received payment for continuing medical education work related to atopic dermatitis that was supported indirectly by Regeneron and/or Sanofi. D. J. Margolis is the chair of the data monitoring committee for many Sanofi clinical trials of dupilumab, and, with respect to atopic dermatitis, has received independent research funding to his institution from the National Institute of Health and Valeant and is a consultant for Pfizer. M. Boguniewicz has received research funding from Regeneron and consulted for Regeneron, Sanofi Genzyme, and Eli Lilly. L. Fonacier has served as a consultant for Regeneron, receiving honoraria, and a speaker for Regeneron; and received research and educational grants from Genentech, Baxter, and Pfizer. M. H. Grayson is a board member of Allergy and Asthma Foundation of America (AAFA) and chair for the AAFA Medical Scientific Council; and has served as a consultant for AstraZeneca, Genentech, and Novartis. E. L. Simpson has served as an investigator for Eli Lilly Co., Galderma, Leo Pharmaceutical Co., Merck, Pfizer, Regeneron Pharmaceuticals, Inc., and a consultant with honorarium for AbbVie Inc., Boehringer-Ingelheim, Dermavant, Eli Lilly Co., Incyte, Leo Pharmaceutical Co., Pfizer, Pierre Fabre Dermo Cosmetique, Regeneron Pharmaceuticals, Inc., and Sanofi Genzyme. P. Y. Ong is a coinvestigator of Atopic Dermatitis Research Network; has consulted for Pfizer and Theravance; and has received research funding from Regeneron. Atopic Dermatitis in America Study is an independent research project of the Asthma and Allergy Foundation of America in partnership with the National Eczema Association and sponsored by Sanofi Genzyme and Regeneron. Conflicts of interest: J. I. Silverberg served as a consultant and/or advisory board member for Abbvie, Asana, Eli Lilly, Galderma, GlaxoSmithKline, Glenmark, Kiniksa, Leo, Menlo, Pfizer, Regeneron-Sanofi, Realm, and Roivant, receiving honoraria; served as a speaker for Regeneron-Sanofi; received research grants from GlaxoSmithKline and Regeneron-Sanofi; and is supported by the Dermatology Foundation. J. M. Gelfand served as a consultant for BMS, Boehringer Ingelheim, GlaxoSmithKline, Janssen Biologics, Menlo Therapeutics, Novartis Corp, Regeneron, Dr Reddy's Labs, UCB (DSMB), Sanofi, and Pfizer Inc, receiving honoraria; receives research grants (to the trustees of the University of Pennsylvania) from Abbvie, Janssen, Novartis, Sanofi, Celgene, Ortho Dermatologics, and Pfizer; received payment for continuing medical education work related to psoriasis that was supported indirectly by Lilly and Ortho Dermatologics; is a co-patent holder of resiquimod for treatment of cutaneous T-cell lymphoma; and is a Deputy Editor for the Journal of Investigative Dermatology, receiving honoraria from the Society for Investigative Dermatology. Z. Chiesa Fuxench has served as a consultant for the National Eczema Association and the Asthma and Allergy Foundation, receiving honoraria, and receives or has received research grants (to the trustees of the University of Pennsylvania) from Regeneron, Sanofi, Tioga, Vanda and Menlo Pharmaceuticals, and Realm Therapeutics for work in atopic dermatitis; and has received payment for continuing medical education work related to atopic dermatitis that was supported indirectly by Regeneron and/or Sanofi. D. J. Margolis is the chair of the data monitoring committee for many Sanofi clinical trials of dupilumab, and, with respect to atopic dermatitis, has received independent research funding to his institution from the National Institute of Health and Valeant and is a consultant for Pfizer. M. Boguniewicz has received research funding from Regeneron and consulted for Regeneron, Sanofi Genzyme, and Eli Lilly. L. Fonacier has served as a consultant for Regeneron, receiving honoraria, and a speaker for Regeneron; and received research and educational grants from Genentech, Baxter, and Pfizer. M. H. Grayson is a board member of Allergy and Asthma Foundation of America (AAFA) and chair for the AAFA Medical Scientific Council; and has served as a consultant for AstraZeneca, Genentech, and Novartis. E. L. Simpson has served as an investigator for Eli Lilly Co., Galderma, Leo Pharmaceutical Co., Merck, Pfizer, Regeneron Pharmaceuticals, Inc., and a consultant with honorarium for AbbVie Inc., Boehringer-Ingelheim, Dermavant, Eli Lilly Co., Incyte, Leo Pharmaceutical Co., Pfizer, Pierre Fabre Dermo Cosmetique, Regeneron Pharmaceuticals, Inc., and Sanofi Genzyme. P. Y. Ong is a coinvestigator of Atopic Dermatitis Research Network; has consulted for Pfizer and Theravance; and has received research funding from Regeneron. Atopic Dermatitis in America Study is an independent research project of the Asthma and Allergy Foundation of America in partnership with the National Eczema Association and sponsored by Sanofi Genzyme and Regeneron .
Keywords
- Access
- Atopic dermatitis
- Disparities
- Eczema
- Emergency department
- Hospitalization
- Outpatient
- Severity
- Urgent care
- Utilization
ASJC Scopus subject areas
- Immunology and Allergy
