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

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.

[1]  R. Hay,et al.  The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions. , 2014, The Journal of investigative dermatology.

[2]  J. Silverberg,et al.  Childhood atopic dermatitis and warts are associated with increased risk of infection: a US population-based study. , 2014, Journal of Allergy and Clinical Immunology.

[3]  J. Silverberg,et al.  Adult eczema prevalence and associations with asthma and other health and demographic factors: a US population-based study. , 2013, The Journal of allergy and clinical immunology.

[4]  J. Silverberg,et al.  Association between severe eczema in children and multiple comorbid conditions and increased healthcare utilization , 2013, Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology.

[5]  L. Akinbami,et al.  Trends in allergic conditions among children: United States, 1997-2011. , 2013, NCHS data brief.

[6]  H. Bisgaard,et al.  Validity of information on atopic disease and other illness in young children reported by parents in a prospective birth cohort study , 2012, BMC Medical Research Methodology.

[7]  T. Agner,et al.  Delay in medical attention to hand eczema: a follow‐up study , 2009, The British journal of dermatology.

[8]  H. Williams,et al.  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 , 2009, The British journal of dermatology.

[9]  R. Damstra,et al.  Twice weekly fluticasone propionate added to emollient maintenance treatment to reduce risk of relapse in atopic dermatitis: randomised, double blind, parallel group study , 2003, BMJ : British Medical Journal.

[10]  C. R. Daniel,et al.  Cost of atopic dermatitis and eczema in the United States. , 2001, Journal of the American Academy of Dermatology.

[11]  A. Hollmén,et al.  Dermatoses determined in a population of farmers in a questionnaire-based clinical study including methodology validation. , 1995, Scandinavian journal of work, environment & health.

[12]  D. Schwarz,et al.  Atopic dermatitis in children: who cares? Who pays? , 1993, Journal of the American Academy of Dermatology.

[13]  J. Silverberg,et al.  Sleep disturbances in adults with eczema are associated with impaired overall health: a US population-based study. , 2015, The Journal of investigative dermatology.

[14]  E. Simpson,et al.  Eczema prevalence in the United States: data from the 2003 National Survey of Children's Health. , 2011, The Journal of investigative dermatology.

[15]  J. Fowler.  Delay in medical attention to hand eczema: a follow-up study , 2011 .

[16]  B. Thiers.  The relative ease of obtaining a dermatologic appointment in Boston: How methods drive results , 2010 .