Healthcare Demographics and Specialty Variation in Atopic Dermatitis: A Retrospective Cohort Analysis

Importance: Atopic dermatitis (AD) is a common chronic skin disease with significant comorbidities and a dramatic impact on quality of life. Despite this, there is little published information about healthcare utilization patterns for adults and children with AD.
Objective: To examine healthcare utilization for patients with AD who are cared for in a regional academic medical center.
Design: Retrospective cohort analysis. Setting: A mixed urban, suburban and rural catchment in the Western NY region.
Participants: All patients seeking medical care for their AD from March of 2011 to September 2015.
Exposure(s) for observational studies: Active AD.
Main Measure(s): Age, sex, race, ethnicity, (demographics) and medical specialty (healthcare utilization). Patients were stratified and analyzed by age group.
Results: Adult AD patients (n=767) accounted for 38.2% of the AD population seeking healthcare in our system with a mean age of 42.7 ± 18.7 years. Among adults, females were seen more commonly than males (65.3% vs. 34.7%). In contrast, both genders were equally represented in the pediatric population (<18 years, n=1,242). The racial and ethnic distribution in the total population was as follows: 49.3% African American, 36.3% Caucasian, and 3.2% Asian, 11.2% other and 0.3% Hispanic. African-Americans accounted for the largest proportion of the pediatric population (<18 years; 58.1%), which was not the case in the adult population (>18 years; 35.2%). Dermatologists cared for the majority of patients (35.2%), followed by pediatricians (25.7%) and family medicine physicians (10.1%). African-Americans were nearly 3 times more likely than Caucasians to visit primary care physicians for their initial AD management (p<0001).
Conclusions and relevance: This study demonstrates that adult AD patients account for over a third of all AD visits in a regional academic medical center. Dermatologists managed the greatest number of AD patients, and the pediatric population was notable for a greater proportion of African American patients relative to the adults. This disparity between the proportions of African Americans in pediatric vs adult patients may reflect reduced access to care for adults. Alternatively, African-Americans may simply have a greater prevalence of pediatric onset AD coupled with greater disease resolution prior to adulthood. African-Americans also appear to seek