Atopic dermatitis in US adults: from population to healthcare utilization

Published online: January 14, 2019

Atopic dermatitis (AD) is a common disorder in adults. AD can be severe and impair physical health, well-being and daily activities. However, not all people with AD go to a doctor for their AD. Little is known about how many adults seek healthcare for their AD in the US and the drivers for such use.

In a research article recently published in The Journal of Allergy and Clinical Immunology: In Practice, Jonathan Silverberg and colleagues analyzed data from a representative sample of the US adult population to see how AD severity and other factors impacted healthcare use overall and for AD in particular. Respondents were asked questions about the severity of their AD and whether they saw a healthcare provider in the outpatient setting, visited an urgent care, emergency department or hospital in the past 12 months for AD or eczema
 
Adults with moderate or severe AD were more likely to see a healthcare provider (HCP) for AD. More than 85% of adults with severe scores for the Patient-Oriented Eczema Measure, Patient Oriented Scoring AD and Numerical Rating Scale for itch saw an HCP for AD. AD severity was the major predictor of seeing a doctor for AD in the outpatient setting. Severe AD was associated with higher rates of 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 at least one urgent care, ED or hospital visit in the past year. Urgent care or ED visits were more common among blacks and Hispanics, those with lower household income, lower education level, and AD prescriptions being denied by their insurance company. When asked for the reasons why they did not see a HCP for their AD or eczema, most responded they either had no symptoms or their symptoms were not bad enough, with fewer patients reporting they had no flares, could not get an appointment when needed, their care was too expensive/not covered by insurance, or the belief that their HCP can’t help them.

Overall, AD patients had relatively low rates of outpatient healthcare utilization and high rates of urgent care, ED and hospital visits. The major predictor of outpatient utilization for AD care was AD severity, though there appear to be racial/ethnic, socio-economic and/or healthcare disparities that may lead to reduced outpatient utilization and increased urgent care, emergency care and hospital utilization. Future interventions are needed to improve access to adequate AD care.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.