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Original Investigation |

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

Jonathan I. Silverberg, MD, PhD, MPH1
[+] 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.
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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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