Health Care Utilization, Patient Costs, and Access to Care in US Adults With Eczema: A Population-Based Study | Dermatology | JAMA Dermatology | JAMA Network
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1.
Silverberg  JI, Hanifin  JM.  Adult eczema prevalence and associations with asthma and other health and demographic factors: a US population-based study.  J Allergy Clin Immunol. 2013;132(5):1132-1138.PubMedGoogle ScholarCrossref
2.
Shaw  TE, Currie  GP, Koudelka  CW, Simpson  EL.  Eczema prevalence in the United States: data from the 2003 National Survey of Children’s Health.  J Invest Dermatol. 2011;131(1):67-73.PubMedGoogle ScholarCrossref
3.
Jackson  KD, Howie  LD, Akinbami  LJ.  Trends in allergic conditions among children: United States, 1997-2011.  NCHS Data Brief. 2013;(121):1-8.PubMedGoogle Scholar
4.
Lapidus  CS, Schwarz  DF, Honig  PJ.  Atopic dermatitis in children: who cares? who pays?  J Am Acad Dermatol. 1993;28(5, pt 1):699-703.PubMedGoogle ScholarCrossref
5.
Ellis  CN, Drake  LA, Prendergast  MM,  et al.  Cost of atopic dermatitis and eczema in the United States.  J Am Acad Dermatol. 2002;46(3):361-370.PubMedGoogle ScholarCrossref
6.
Hald  M, Agner  T, Blands  J, Johansen  JD; Danish Contact Dermatitis Group.  Delay in medical attention to hand eczema: a follow-up study.  Br J Dermatol. 2009;161(6):1294-1300.PubMedGoogle ScholarCrossref
7.
Weingold  DH, Lack  MD, Yanowitz  KL.  The relative ease of obtaining a dermatologic appointment in Boston: how methods drive results.  J Am Acad Dermatol. 2009;60(6):944-948.PubMedGoogle ScholarCrossref
8.
Silverberg  JI, Garg  NK, Paller  AS, Fishbein  AB, Zee  PC.  Sleep disturbances in adults with eczema are associated with impaired overall health: a US population-based study.  J Invest Dermatol. 2015;135(1):56-66.PubMedGoogle ScholarCrossref
9.
Hay  RJ, Johns  NE, Williams  HC,  et al.  The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions.  J Invest Dermatol. 2014;134(6):1527-1534.PubMedGoogle ScholarCrossref
10.
Silverberg  JI, Silverberg  NB.  Childhood atopic dermatitis and warts are associated with increased risk of infection: a US population-based study.  J Allergy Clin Immunol. 2014;133(4):1041-1047. Published online 2013.PubMedGoogle ScholarCrossref
11.
Silverberg  JI, Simpson  EL.  Association between severe eczema in children and multiple comorbid conditions and increased healthcare utilization.  Pediatr Allergy Immunol. 2013;24(5):476-486.PubMedGoogle ScholarCrossref
12.
Berth-Jones  J, Damstra  RJ, Golsch  S,  et al; Multinational Study Group.  Twice weekly fluticasone propionate added to emollient maintenance treatment to reduce risk of relapse in atopic dermatitis: randomised, double blind, parallel group study.  BMJ. 2003;326(7403):1367.PubMedGoogle ScholarCrossref
13.
Flohr  C, Weinmayr  G, Weiland  SK,  et al; ISAAC Phase Two Study Group.  How well do questionnaires perform compared with physical examination in detecting flexural eczema? findings from the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Two.  Br J Dermatol. 2009;161(4):846-853.PubMedGoogle ScholarCrossref
14.
Susitaival  P, Husman  L, Hollmén  A, Horsmanheimo  M.  Dermatoses determined in a population of farmers in a questionnaire-based clinical study including methodology validation.  Scand J Work Environ Health. 1995;21(1):30-35.PubMedGoogle ScholarCrossref
15.
Vissing  NH, Jensen  SM, Bisgaard  H.  Validity of information on atopic disease and other illness in young children reported by parents in a prospective birth cohort study.  BMC Med Res Methodol. 2012;12:160.PubMedGoogle ScholarCrossref
Original Investigation
July 2015

Health Care Utilization, Patient Costs, and Access to Care in US Adults With Eczema: A Population-Based Study

Author Affiliations
  • 1Departments of Dermatology, Preventive Medicine, and Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
JAMA Dermatol. 2015;151(7):743-752. doi:10.1001/jamadermatol.2014.5432
Abstract

Importance  Little is known about the health burden of adult eczema in the United States.

Objective  To study the out-of-pocket costs, health care access and utilization in adult eczema in the United States.

Design, Setting, and Participants  Two US population-based studies, the 2010 and 2012 National Health Interview Surveys, surveyed 27 157 and 34 613 adults (ages 18-85 years).

Exposures  History of eczema.

Main Outcomes and Measures  The out-of-pocket costs, lost workdays, days in bed, and access to care.

Results  Adults with eczema had $371 to $489 higher out-of-pocket costs per person-year compared with those without eczema, with higher odds of increased out-of-pocket costs (survey multinomial logistic regression, adjusted odds ratios [ORs] [95% CIs] for NHIS 2012, <$1 to 499: OR, 1.27; 95% CI, 1.05-1.54; $500 to $1999: OR, 1.49; 95% CI, 1.22-1.81; $2000-$2999: OR, 1.74; 95% CI, 1.36-2.21; $3000-$4999: OR, 2.07; 95% CI, 1.56-2.73; ≥$5000: OR, 1.74; 95% CI, 1.34-2.27; P < .001). Adults with eczema were significantly more likely to have at least 6 lost workdays from all causes (OR, 1.53; 95% CI, 1.26-1.84), 1 to 2 half-days (OR, 1.31; 95% CI, 1.14-1.51); 3 to 5 half-days (OR, 1.84; 95% CI, 1.54-2.20), and at least 6 half-days (OR, 2.24; 95% CI, 1.92-2.62) in bed and increased health care utilization with more physician visits (1-3 visits: OR, 1.70; 95% CI, 1.40-2.07; 4-9 visits: OR, 2.45; 95% CI, 2.00-3.00; and ≥10 visits: OR, 3.33; 95% CI, 2.69-4.12), urgent or emergency care visits (1-3 visits: OR, 1.46; 95% CI, 1.29-1.66; 4-9 visits: OR, 1.81; 95% CI, 1.27-2.57; and ≥10 visits: OR, 2.43; 95% CI, 1.19-4.99) and hospitalizations (OR, 1.37; 95% CI, 1.17-1.60). Adults with eczema had significantly limited access to care with inability to afford prescription medications (OR, 2.36; 95% CI, 1.92-2.81), were unable to get an appointment soon enough (OR, 2.04; 95% CI, 1.73-2.41), had to wait too long to see a physician (OR, 1.59; 95% CI, 1.28-1.97), had delayed care (OR, 1.73; 95% CI, 1.49-2.01), and were not able to get care (OR, 1.66; 95% CI, 1.40-1.97) because of worry about the related costs.

Conclusions and Relevance  This study demonstrates a large health burden of eczema in adults and suggests substantial out-of-pocket costs, indirect costs from lost workdays and sick days, and increased health care utilization.

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