Associations of childhood eczema severity: A US population-based study

Background: Little is known about the predictors of eczema severity in the US population. Objectives: We sought to determine the distribution and associations of childhood eczema severity in theUnitedStates. Methods: We analyzed the data from the 2007 National Survey of Children's Health, a prospective questionnairebased study of a nationally representative sample of 91,642 children (range, 0Y17 years). Results: The prevalence of childhood eczema was 12.97% (95% confidence interval [95% CI], 12.42Y13.53); 67.0% (95% CI, 64.8Y69.2) had mild disease, 26.0% (95% CI, 23.9Y28.1) had moderate disease, and 7.0% (95% CI, 5.8Y8.3) had severe disease. There was significant statewide variation of the distribution of eczema severity (Rao-Scott W2, P = 0.004), with highest rates of severe disease in Mid-Atlantic and Midwestern states. In univariate models, eczema severity was increased with older age, African American and Hispanic race/ethnicity, lower household income, oldest child in the family, home with a single mother, lower paternal/maternal education level, maternal general health, maternal/paternal emotional health, dilapidated housing, and garbage on the streets. In multivariate survey logistic regression models using stepwise and backward selection, moderate-to-severe eczema was associated with older age, lower household income, and fair or poor maternal health but inversely associated with birthplace outside the United States. Conclusions: These data indicate that environmental and/or lifestyle factors play an important role in eczema severity.