Eczema Prevalence Findings Indicate Potential Diagnosis Disparities by Race

Researchers found disparities in the diagnosis and risk of eczema over a 20-year period among patients from 6 ethnic/racial populations, according to cross-sectional study findings published in JAMA Dermatology.

Using US National Health Interview Survey data from 1997 to 2018, study authors determined eczema prevalence in the past year overall, by age (0-5, 6-10, 11-17 years), by sex, by race (American Indian or Alaskan Native, Asian, Black, multiracial, White), and by Hispanic ethnicity.

“Surveys suggest that disparities in care may exist between sociodemographic subgroups,” the study authors wrote. “Research on the prevalence of eczema in children in the United States is limited.”

They specifically asked a question to determine the prevalence of eczema or skin allergy during the past 12 months.

Via the unweighted count, there were 260,888 cases of eczema overall. By age, most of these appeared among children ages 11 to 17 years (n = 105,291), followed by 0 to 5 years (n = 88,523) and 6 to 10 years (n = 67,074). In addition, more cases were seen among male vs female patients (134,196 vs 126,692), and the most cases (75.1%) were seen among White patients. Seventy-nine percent of the patients overall did not report Hispanic ethnicity.

There was a universal rise in eczema prevalence from 1997 to 2010 for all age groups, but children aged 11 to 17 years were the only ones among whom prevalence rose for the entire study period. Overall, eczema prevalence rose from 7.9% (95% CI, 7.3%-8.5%) of cases in 1997 to 12.6% (95% CI, 11.6%-13.6%) in 2018; this corresponded to an average annual percentage change (AAPC) of 2.8%.

Prevalence increases were close to equal among male and female patients. Cases among males rose from 7.7% (95% CI, 7.0%-8.5%) to 12.2% (95% CI, 11.0%-13.6%), for an AAPC of 2.7%, and cases among female patients rose from 8.1% (95% CI, 7.3-9.0) to 12.9% (95% CI, 11.6%-14.3%), for an AAPC of 2.8%.

Among the patient races evaluated, cases rose the most among multiracial patients between 1997 and 2018:

• Multiracial: 9.7% (95% CI, 7.3%-12.7%) to 16.7% (95% CI, 13.1%-21.0%); AAPC, 3.9%
• Black: 10.1% (95% CI, 8.6%-11.8%) to 18.4% (95% CI, 15.4%-21.8%); AAPC, 3.5%
• Asian: 11.1% (95% CI, 8.0%-15.3%) to 11.5% (95% CI, 8.8-14.8); AAPC, 2.6%
• American Indian or Alaskan Native: 3.4% (95% CI, 1.3%-8.5%) to 6.5% (95% CI, 3.2%-12.8%); AAPC, 2.5%
• White: 7.3% (95% CI, 6.7%-8.0%) to 11.3% (95% CI, 1.9%-3.1%); AAPC, 2.5%

Prevalence also rose slightly more among those who did not report Hispanic ethnicity compared with those who did: Cases in this subanalysis rose from 8.3% (95% CI, 7.7%-9.0%) to 13.2% (95% CI, 12.1%-14.4%) and 5.6% (95% CI, 4.7%-6.6%) to 10.6% (95% CI, 9.0%-12.4%), respectively, for corresponding AAPCs of 2.7% vs 2.5%.

Data also show the following:

• Prevalence of eczema among males remained steady after 2011 vs increasing for the entire period among females
• White and Asian children had increasing trends of eczema for the entire study period
• Eczema prevalence rose in Hispanic children for all of the study vs only increasing between 1997 and 2010 for non-Hispanic children

“This study found an increasing trend in the prevalence of eczema from 1997 to 2018 for noninstitutionalized children in the United States, with significant differences between race and ethnicity,” the study authors concluded. “Specifically, larger yearly AAPCs in children with eczema in Black and multiracial subgroups (compared with White) were identified.”

The recommend more research among pediatric racial and ethnic groups, especially because, as they highlight, findings from a 2019 study do not show an association between African genetic ancestry and risk of atopic dermatitis compared with European ancestry, “suggesting that contextual variables such as socioeconomic status, environment, and health care access and quality may be factors in eczema prevalence.”

Reference

Choragudi S, Yosipovitch G. Trends in the prevalence of eczema among US children by age, sex, race, and ethnicity from 1997 to 2018. JAMA Dermatol. 2023;159(4):454-456. doi:10.1001/jamadermatol.2022.6647