Sociodemographic Disparities Found in Health Care Use in Children With Eczema

White children with eczema have higher trending rates of attending a well-child visit and being seen by a medical specialist while having a lower average annual percentage change (AAPC) in overall eczema prevalence compared with Black children and those in other minority subgroups. These are among the study findings published in Dermatitis.

Researchers assessed the prevalence of health care use among the children within the previous 12 months based on whether the children attended a well-child checkup, were seen by a medical specialist, and were seen by a mental health specialist. They analyzed data from the National Health Interview Survey (NHIS) from 2006 to 2018 in children aged 0 to 17 years. The analysis used unweighted frequencies and survey-weighted prevalence for categorical variables.

The cohort included 149,379 children with a mean age of 8.58 (95% CI, 8.50-8.58) years. Among the participants, 39.1% were aged 11 to 17 years, 51.1% were boys, 74.5% were White, and 14.9% were Black. Eczema prevalence increased from 10.1% (95% CI, 9.4%-10.9%) in 2006 to 12.6% (95% CI, 11.6%-13.6%) in 2018.

The proportion of patients who had a well-child checkup increased from 2006 to 2018 in children with eczema (AAPC, 1.0%; 95% CI, 0.7%-1.4%) and without eczema (AAPC, 1.5%; 95% CI, 1.1%-1.9%). The proportion of participants who were seen by a medical specialist was stagnant in that period for children with eczema, and the proportion of those who were seen by a medical specialist increased in children without eczema (AAPC, 1.1%; 95% CI, 0.2%-1.9%).

The proportion of children who were seen by a mental health professional increased in children with eczema (AAPC, 2.4%; 95% CI, 0.4%-4.5%) as well as in children without eczema (AAPC, 3.2%; 95% CI, 1.9%-4.5%) during the same period.

For children with eczema only and no other atopic disease, increasing trends were observed in the proportion of those who attended a well-child checkup from 2006 to 2018 among children who were White, Black, and of other minority groups. In a comparison of the AAPC of the proportion of children who had a well-child checkup in minority subgroups, White children had a much greater percentage increase vs Black children (AAPC difference, 0.6%; 95% CI, -0.1% to 1.3%; P =.02).

In children who had eczema only and no other atopic disease, an increasing trend occurred in the proportion of those who were seen by a medical specialist among White children (AAPC, 2.3%; 95% CI, 0.1%-4.5%). The trends were stagnant for the Black children and those in other minority groups. The proportion of children who were seen by a medical specialist in the other age, sex, and Hispanic ethnicity subgroups also was stagnant from 2006 to 2018.

For children with eczema only and no other atopic disease, increasing trends of being seen by a mental health professional were found only in the boy subgroup (AAPC, 3.2%; 95% CI, 0.8%-5.7%) and non-Hispanic subgroup (AAPC, 2.4%; 95% CI, 0.2%-4.6%). The proportion of children who were seen by a mental health professional was stagnant in all other sociodemographic groups, including among girls, all age groups, and other minority groups.

Limitations of the study include caregiver-reported eczema history that was not confirmed with diagnostic testing. Also, the analysis was based on cross-sectional data, and some subgroups had small sample sizes.

The researchers conclude, “Promoting adherence to attending well-child checkups and medical specialist referrals among minority race and Hispanic children as well as improving awareness among primary care physicians on when to refer to dermatology and mental health could reduce barriers to care.”

Disclosure: One of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.