206 Racial/ethnic differences in healthcare utilization and school attendance among children with atopic dermatitis in the Pediatric Eczema Elective Registry

Abstract

Little is known about healthcare utilization for atopic dermatitis (AD) and the impact of AD on school attendance especially among racial/ethnic minorities. We aimed to examine healthcare utilization and school missed due to AD by race/ethnicity among a cohort of U.S. children with AD. We performed a cross-sectional study of baseline data for children (ages 2-17) with physician-confirmed AD enrolled in the Pediatric Eczema Elective Registry (PEER; N=7,901). All subjects had to have used pimecrolimus cream for at least 6 weeks at the time of enrollment. Study outcomes were: 1) healthcare utilization by visit type, and 2) any school missed in the 6 months prior to enrollment. We performed multivariable logistic regression to assess the association between the outcomes and race/ethnicity, adjusting for age, gender, annual household income, history of asthma and allergic rhinitis, and AD severity (AD severity variable for outcome 2 only). For outcome 1, an interaction term of AD severity by race/ethnicity was included. The reference group was non-Hispanic whites. Non-Hispanic blacks (odds ratio [OR]=2.3; 95% CI=1.6-3.2) and Hispanics (3.1; 2.0-4.7) were more likely than whites to have visited the emergency room for their AD. Blacks were also less likely to have seen a dermatologist (0.6; 0.5-0.7). Interaction between race/ethnicity and AD severity was statistically significant but had small effects on the main ORs. Blacks (1.3; 1.1-1.6), Hispanics (1.8; 1.5-2.3), and Asians (3.6; 2.6-5.0) were more likely to have missed school due to their AD. Our results suggest disparities in healthcare utilization and poorer school attendance among racial/ethnic minority children with AD, after adjustment for AD severity. Further studies are needed to better understand these disparities and improve healthcare for and school attendance among racial/ethnic minority children with AD.