School Absences Due to Atopic Dermatitis Vary by Race/Ethnicity

Compared with non-Hispanic white children, Hispanic children were 3.4-fold more likely to have missed at least 6 days of school because of atopic dermatitis.

Chronic school absenteeism among children with atopic dermatitis has shown variation by race/ethnicity with Hispanic children having the highest rate of atopic dermatitis-related absenteeism, according to a study recently published in JAMA Dermatology. .

This study included 8015 children (53.3% girls; median age, 6.6 years) from the Pediatric Eczema Elective Registry (PEER) between 2004 and 2017. Children were between 2 and 17 years old and had a physician-confirmed atopic dermatitis diagnosis. Among them, 50.9% (n=4079) were non-Hispanic black, 32.1% (n=2576) were non-Hispanic white, and 10.6% (n=851) were Hispanic. All children or caregivers completed a questionnaire on medical conditions, demographic features, history and treatment for atopic dermatitis, and how many school days had been missed in the last 6 months.

The study’s primary outcome was at least 6 missed school days related to atopic dermatitis within this period, a threshold that meets the definition of chronic school absenteeism set by the US Department of Education. Logistic regression was used to examine the association between race/ethnicity and chronic absenteeism.

Among the 7272 children were enrolled in either day care or school, 3.3% (n=241) were absent at least 6 days in the past 6 months. Compared with non-Hispanic white children, at least 6 absences in 6 months was likelier among Hispanic (adjusted odds ratio [aOR], 3.41; 95% CI, 2.16-5.38) and non-Hispanic black (aOR, 1.49; 95% CI, 1.01-2.18) children.

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Chronic school absenteeism was also associated with being younger (aOR, 0.95;  95% CI, 0.9-0.999), having uncontrolled atopic dermatitis (aOR, 6.36; 95% CI, 2.71-14.89), comorbid allergic rhinitis (aOR, 2.03; 95% CI, 1.35-3.05) or asthma (aOR, 1.78; 95% CI, 1.31-2.4), household income in the range of $50,000 to $99,999 (aOR, 0.55; 95% CI, 0.31-0.97), and longer atopic dermatitis duration (aOR, 1.07; 95% CI, 1.01-1.13).

Limitations to this study included the use of self-reported data, potential unmeasured confounding, limited results in other racial groups, and limited generalizability to all children with atopic dermatitis.

The study researchers concluded that “[our] findings suggest racial/ethnic disparities in school absenteeism associated with [atopic dermatitis] that differ from estimates of school absenteeism by race/ethnicity in the United States which find chronic absenteeism to be highest among non-Hispanic black children (17.3%), followed by Hispanic children (14.1%) and non-Hispanic white children (12.7%). In contrast, we observed [atopic dermatitis]-related school absenteeism to be highest among Hispanic children followed by non-Hispanic black and non-Hispanic white children.”

Disclosure: Several authors report financial associations with pharmaceutical companies. For a full list of disclosures, visit the reference.

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Wan J, Margolis DJ, Mitra N, Hoffstad OJ, Takeshita J. Racial and ethnic differences in atopic dermatitis–related school absences among US children [published online May 22, 2019]. JAMA Dermatol. doi: 10.1001/jamadermatol.2019.0597