Atopic Dermatitis in US Adults

From Population to Health Care Utilization

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

Research output: Contribution to journalArticle

1 Citation (Scopus)

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 languageEnglish (US)
Pages (from-to)1524-1532.e2
JournalJournal of Allergy and Clinical Immunology: In Practice
Volume7
Issue number5
DOIs
StatePublished - May 1 2019

Fingerprint

Patient Acceptance of Health Care
Atopic Dermatitis
Population
Ambulatory Care
Hospital Emergency Service
Outpatients
Eczema
Prescriptions
Healthcare Disparities
Insurance Carriers
Insurance Coverage

Keywords

  • Access
  • Atopic dermatitis
  • Disparities
  • Eczema
  • Emergency department
  • Hospitalization
  • Outpatient
  • Severity
  • Urgent care
  • Utilization

ASJC Scopus subject areas

  • Immunology and Allergy

Cite this

Silverberg, J. I., Gelfand, J. M., Margolis, D. J., Boguniewicz, M., Fonacier, L., Grayson, M. H., ... Simpson, E. (2019). Atopic Dermatitis in US Adults: From Population to Health Care Utilization. Journal of Allergy and Clinical Immunology: In Practice, 7(5), 1524-1532.e2. https://doi.org/10.1016/j.jaip.2019.01.005

Atopic Dermatitis in US Adults : From Population to Health Care Utilization. / Silverberg, Jonathan I.; Gelfand, Joel M.; Margolis, David J.; Boguniewicz, Mark; Fonacier, Luz; Grayson, Mitchell H.; Ong, Peck Y.; Chiesa Fuxench, Zelma; Simpson, Eric.

In: Journal of Allergy and Clinical Immunology: In Practice, Vol. 7, No. 5, 01.05.2019, p. 1524-1532.e2.

Research output: Contribution to journalArticle

Silverberg, JI, Gelfand, JM, Margolis, DJ, Boguniewicz, M, Fonacier, L, Grayson, MH, Ong, PY, Chiesa Fuxench, Z & Simpson, E 2019, 'Atopic Dermatitis in US Adults: From Population to Health Care Utilization', Journal of Allergy and Clinical Immunology: In Practice, vol. 7, no. 5, pp. 1524-1532.e2. https://doi.org/10.1016/j.jaip.2019.01.005
Silverberg JI, Gelfand JM, Margolis DJ, Boguniewicz M, Fonacier L, Grayson MH et al. Atopic Dermatitis in US Adults: From Population to Health Care Utilization. Journal of Allergy and Clinical Immunology: In Practice. 2019 May 1;7(5):1524-1532.e2. https://doi.org/10.1016/j.jaip.2019.01.005
Silverberg, Jonathan I. ; Gelfand, Joel M. ; Margolis, David J. ; Boguniewicz, Mark ; Fonacier, Luz ; Grayson, Mitchell H. ; Ong, Peck Y. ; Chiesa Fuxench, Zelma ; Simpson, Eric. / Atopic Dermatitis in US Adults : From Population to Health Care Utilization. In: Journal of Allergy and Clinical Immunology: In Practice. 2019 ; Vol. 7, No. 5. pp. 1524-1532.e2.
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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.",
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T1 - Atopic Dermatitis in US Adults

T2 - From Population to Health Care Utilization

AU - Silverberg, Jonathan I.

AU - Gelfand, Joel M.

AU - Margolis, David J.

AU - Boguniewicz, Mark

AU - Fonacier, Luz

AU - Grayson, Mitchell H.

AU - Ong, Peck Y.

AU - Chiesa Fuxench, Zelma

AU - Simpson, Eric

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N2 - 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.

AB - 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.

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KW - Atopic dermatitis

KW - Disparities

KW - Eczema

KW - Emergency department

KW - Hospitalization

KW - Outpatient

KW - Severity

KW - Urgent care

KW - Utilization

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