190 Oregon’s War On MelanomaTM: A statewide public health experiment

Abstract

Little is known about the predictors of healthcare utilization among US adults with atopic dermatitis (AD). We determined the proportion and predictors of utilization in outpatient, urgent care, emergency department (ED) and hospital settings in US adults. A cross-sectional, population-based study of 3,495 adults was performed. Overall, 10.42% (95% confidence interval: 8.55-12.28%; weighted frequency: 25,844,871) reported a diagnosis of AD or eczema, 7.39% (5.81-8.97%; 18,324,869) met United Kingdom Working Party criteria, and 3.56% (2.40-4.72%; 8,830,095) met both. 31.8% (2,711,690) had a severe score for POEM, PO-SCORAD and/or NRS-itch, with 4.0% (337,586) having severe scores for all three. Outpatient utilization for AD was low for mild disease (29.3-34.7%) and increased by severity (moderate: 36.2-49.8%; severe: 50.6-86.6%). Severe AD was associated with being uninsured, not having full prescription coverage, AD prescriptions being denied by insurers, and costs of AD medications being problematic. One in 10 adults with AD had 1 urgent care, ED or hospital visit in the past year. Urgent care or ED visits were significantly more common among blacks and Hispanics, lower household income, lower education level, and AD prescriptions being denied by their insurance company. In conclusion, adults with AD had low rates of outpatient and high rates of urgent care, ED and hospital visits. The major predictor of outpatient utilization for AD care was AD severity. Racial/ethnic, socio-economic and/or healthcare disparities may reduce outpatient utilization and increase urgent, ED and hospital utilization.