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Racial and ethnic differences in health care utilization for childhood eczema: An analysis of the 2001-2013 Medical Expenditure Panel Surveys - 23/11/17

Doi : 10.1016/j.jaad.2017.08.035 
Alexander H. Fischer, MD, MPH a, Daniel B. Shin, PhD b, David J. Margolis, MD, PhD b, c, Junko Takeshita, MD, PhD, MSCE b, c,
a Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland 
b Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvannia 
c Department of Biostatistics Epidemiology and Informatics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvannia 

Correspondence to: Junko Takeshita, MD, PhD, MSCE, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, 7th Floor, South Tower, Office 728, Philadelphia, PA 19104.University of Pennsylvania Perelman School of Medicine3400 Civic Center Blvd, 7th Floor, South Tower, Office 728PhiladelphiaPA19104

Abstract

Background

Eczema is a common chronic inflammatory disease of the skin. Studies suggest differences in disease prevalence and severity by race/ethnicity. Our knowledge of health care utilization for eczema among different racial/ethnic groups remains limited.

Objective

To evaluate health care utilization for childhood eczema among different racial/ethnic groups in the United States.

Methods

We performed a cohort study of non-Hispanic white (reference), non-Hispanic black, and Hispanic white individuals under the age of 18 years with caregiver-reported eczema (N = 2043) pooled from the 2-year longitudinal cohorts of the 2001-2013 Medical Expenditure Panel Surveys. Health care utilization outcomes were evaluated over the 2-year follow-up period by race/ethnicity using multivariable regression.

Results

Among all children with eczema, non-Hispanic blacks were less likely than whites to report an ambulatory visit for eczema (adjusted odds ratio [ORadj] 0.69; 95% confidence interval [CI] 0.51-0.92). Among those with ≥1 ambulatory visit for eczema, non-Hispanic blacks reported more visits (adjusted incidence rate ratio [IRRadj] 1.68; 95% CI 1.10-2.55) and prescriptions (IRRadj 1.22; 95% CI 1.01-1.46) than whites and were more likely than whites to report a dermatology visit (ORadj 1.82; 95% CI 1.06-3.14) for eczema.

Limitations

We used caregiver- or self-reported data.

Conclusion

Our findings suggest disparities in health care utilization for eczema among non-Hispanic black children despite utilization patterns suggestive of more severe disease.

Le texte complet de cet article est disponible en PDF.

Key words : ambulatory visits, atopic dermatitis, eczema, ethnicity, health care disparities, health care utilization, prescriptions, race

Abbreviations used : CI, ICD-9-CM, MEPS, OR, IRR


Plan


 Funding sources: Dr Takeshita is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases through grant K23-AR068433.
 Conflicts of interest: Dr Margolis has served as a consultant for Sanofi and GlaxoSmithKline, receiving honoraria, and has received a research grant (to the Trustees of the University of Pennsylvania) from Valeant. Dr Takeshita has received a research grant from Pfizer Inc (to the Trustees of the University of Pennsylvania) and payment for continuing medical education work related to psoriasis that was supported indirectly by Eli Lilly. All other authors have no conflicts of interest to report.
 Previously presented: Results were presented in part at the Society for Investigative Dermatology 2017 annual meeting in Portland, Oregon, April 26-29, 2017.
 Reprints not available from the authors.


© 2017  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 77 - N° 6

P. 1060-1067 - décembre 2017 Retour au numéro
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