174 Outpatient healthcare utilization patterns for atopic dermatitis among US children and adults

Abstract

We aimed to characterize trends and predictors of outpatient healthcare utilization for AD in the US. Data from the National Ambulatory Medical Care Survey (NAMCS) were analyzed, including 110,095 pediatric and 642,140 adult outpatient visits. Overall, AD visits occurred predominantly in primary care providers (PCPs) (768,882 mean visits annually), followed by dermatologists (466,529), and allergists (18,445). The frequency of AD visits significantly increased significantly from 1996-1999 to 2012-2015 overall (from 867,649 annual visits to 1,950,546, Rao-Scott Chi square, P=0.02), and particularly among PCPs (from 339,889 to 1,025,739, P=0.02). Whereas, the frequency of AD visits to dermatologists decreased (P=0.01). AD visits to any provider were significantly more common among children age 0-4 years (32.0%), followed by 5-9 (10.6%) and 10-19 years (11.6%), remained fairly steady between ages 20-89 years (1.0%-4.7%), and increased at age >90 years (20.7%) (P<0.01). Adults had lower odds of seeing a dermatologist for AD, in particular, if they were Asian (adjusted odds ratio [95% confidence interval]: 0.20 [0.06-0.65]), lived in the southern US (0.25 [0.08-0.82]) or had comorbid asthma (0.00 [0.00-0.02]) or allergic rhinitis (0.04 [0.00-0.69]). Adults had greater odds of seeing an allergist with an unknown source of insurance (12.08 [1.09-133.43]) or comorbid allergic rhinitis (63.53 [4.94-816.80]) or food allergies (98.14 [3.29-2,926.76]). Children were more likely to see a dermatologist if they had private (6.12 [2.73-13.73]) or no insurance (18.02 [3.73-87.18]). AD visits were more likely to be acute visits among PCPs (51.5%), and chronic visits among dermatologists (41.2%). Our results suggest that PCPs are increasingly seeing a larger share of children and adults with AD in the outpatient setting in the US. Whereas, allergists are predominantly seeing patients with atopic comorbidities.