Racial and ethnic disparities abound in eczema care

Black children are more likely to suffer from severe cases of eczema, but are less likely to see a doctor for treatment than white children, according to a new report.

Junko Takeshita, MD, PhD, MSCE, assistant professor of Dermatology and Epidemiology at the University of Pennsylvania Perelman School of Medicine, Philadelphia, says 40% of children in the United States are not seeing any medical providers for treatment of their eczema.

Of those children, black children are 30% less likely to receive medical care than white children, with that figure not taking into account differences in socioeconomic or health insurance status. Takeshita says researchers also found that although black children were less likely to receive medical care for eczema, those who did had more visits with physicians and received more prescriptions than white children. Black children were also more likely to see a dermatologist for the condition, she notes, suggesting more severe skin disease in black children compared with white children.

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Eczema, also known as atopic dermatitis, is a chronic inflammatory skin condition characterized by pruritic, pink to red eruptions on the skin. The exact etiology of eczema is unknown, but is associated with allergies. Onset typically occurs around age 2 to 3 months, affecting the face first in most cases and extending to extensor areas of the body by 10 months. Infants with eczema may suffer from sleep deprivation attributed to discomfort, and older children with severe cases may experience fatigue or weakness and problems at school. Eczema can continue into adulthood, with intermittent exacerbations and remissions.

According to the Centers for Disease Control and Prevention (CDC), prevalence of eczema and other skin allergies increased among all races of children between 2000 and 2010. According to the CDC’s data, black children saw the greatest increase in diagnoses of 8.6% to 17.1%. Prevalence rose in white children between 7.6% and 12.6%, and between 5% and 9.9% among Hispanic children. The CDC reports that eczema affects around 11% of children overall.

According to this study, of the 3 million children with eczema, 66% are white; 18% are black; and 16% are Hispanic. More than 62% of white children saw a physician for treatment of the condition, compared with 58% of Hispanic children and just 51.9% of black children.

Minority children with eczema were also younger and more likely to have asthma. Whereas the overall statistics did not take into account social and economic factors or insurance status, researchers also note that minority children with eczema were in fact less likely to have private insurance and to come from low-income households.

The study, published in the Journal of the American Academy of Dermatology, is the first to look at racial and ethnic differences in healthcare usage on an individual level instead of based on samples from outpatient visits.

Researchers reviewed 2 years’ worth of caregiver-reported data on eczema in white and black individuals aged younger than 18 years using the 2001-2013 Medical Expenditure Panel surveys. Researchers found that among all the children studied, black children were less likely to see an outpatient provider for eczema, but when they did, they required more vigorous treatment.

Researchers were not able to uncover a reason for this disparity, Takeshita says. She adds that in addition to knowing the reason, resolving the disparity would require reaching those individuals who are not currently accessing care for their skin disease.

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“It will be difficult for medical providers including pediatricians, alone, to close this gap,” Takeshita says. “I think the most important thing right now is for pediatricians to be aware that a disparity exists. With eczema being so common among children, it is also important for pediatricians to recognize and have a basic understanding of the disease so that they can identify and address the problem even if they are seeing a child for a routine visit or for some other issue.”

Takeshita plans to continue her research, investigating the cause of the disparities in eczema care. As a next step, she hopes to interview children with eczema who are not receiving treatment and their caregivers to determine what barriers exist. She says she hopes the data she collects will help in developing interventions to ensure equal care for all children with eczema.