Medicaid, Depression, ADHD Raise Risks for Hospitalization in Pediatric Atopic Dermatitis

ECZEMA, atopic dermatitis
Researchers sought to determine risk factors for hospitalization in children with atopic dermatitis.

In children with atopic dermatitis (AD), factors associated with higher odds for hospitalization include being a race other than white; having Medicaid or no insurance; experiencing an asthma attack in the past year; feeling depressed; having a diagnosis of attention-deficit/hyperactivity disorder (ADHD), hay fever, respiratory allergy and/or digestive allergy; and having an infection, according to study results published in the Journal of the American Academy of Dermatology.

The study relied on data from the 1997-2017 National Health Interview Survey, which included 251,555 individuals from households throughout the United States. Only 1 child per household was randomly selected for inclusion in the study and the 1-year prevalence of AD was identified. The researchers also identified the number of overnight hospitalizations in the database cohort. Multivariable logistic regression models evaluated the association between AD and several variables, including demographics, physician interaction, infections, allergies, and mental health.

An increase in AD prevalence was observed between 1997 (8%; 95% CI, 7.5%-8.4%) and 2017 (13.6%; 95% CI, 12.8%-14.4%]). The overall number of hospitalizations with ≥1 overnight stay was 1641.

Children with AD were more likely to have an overnight hospitalization in the past year compared with children without AD (1 to 2 hospitalizations: adjusted odds ratio [aOR] 1.17; 95% CI, 1.05-1.3; ≥3 hospitalizations: aOR 1.64; 95% CI, 1.19-2.25).

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In children with AD, factors associated with higher hospitalization risk included black (aOR 1.01; 95% CI, 1-1.01; P =.01) and other race (aOR 1.15; 95% CI, 1.14-1.16; P <.0001), Medicaid (aOR 1.27; 95% CI, 1.27-1.28; P <.0001) or no insurance (aOR 1.18; 95% CI, 1.18-1.19; P <.0001), outpatient physician interaction (aOR 7.43; 95% CI, 7.18-7.68; P <.0001), asthma attack in the past year (aOR 2.32; 95% CI, 2.31-2.34; P <.0001), feeling depressed (aOR 1.98; 95% CI, 1.97-1.99; P <.0001), ADHD (aOR 1.19; 95% CI, 1.18-1.19; P <.0001), hay fever and/or respiratory allergy (aOR 1.15; 95% CI, 1.14-1.15; P <.0001), digestive allergy (aOR 1.35; 95% CI, 1.35-1.36; P <.0001), and infection (aOR 1.47; 95% CI, 1.46-1.48; P <.0001).

A limitation of the study included the lack of assessment of patients’ therapies and whether these therapies contributed to hospitalization risk.

The researchers added that additional research is “needed to determine optimal strategies to prevent hospitalization in children with AD.”

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Hua T, Silverberg JI. Atopic dermatitis is associated with increased hospitalization in United States children [published online May 11, 2019]. J Am Acad Dermatol. doi:10.1016/j.jaad.2019.05.019