Predictors of Hospitalization and Cost of Care

Atopic dermatitis (AD) is a common chronic inflammatory skin disease. It can refer to a cluster of conditions, the most common of which is eczema. AD occurs across the population without regard to gender or age. It is much more common for atopic dermatitis to begin in childhood; only 5% of new cases begin after age 18. People can experience different levels of severity at different times during the course of the disease.

In the United States, approximately 10% of people are affected by the condition. The prevalence is higher among individuals who live in cities and climates that experience extreme cold and heat. Dry and scaly rashes generally characterize AD. Sometimes people experience oozing blisters and small bumps that look like pimples. The most common complaint of those with AD is the intense itch it causes.1

Few studies have attempted to quantify the impact of cost of atopic dermatitis on expenses for inpatient hospitalization. Some studies have noted increased health care use including “more frequent visits to primary care providers and specialists, and higher rates of hospitalization2.”

Looking back over admissions and discharge data researchers identified complexities associated with identifying accurate classification of diagnoses. Clinical use of different names and related conditions resulted in no singular coding method. Combined with the fact that people are admitted to the hospital for multiple reasons can make clear identification of AD more difficult to track.3

Characteristics of hospitalized AD patients2

Researchers found that hospitalized Atopic Dermatitis patients were more likely to be:

  • Ethnically non-white
  • More prevalent in African American/Black children
  • Low income
  • Enrolled in Medicaid or without health insurance
  • Presenting multiple chronic conditions

Predictors of hospitalization, length of stay, and cost of care

The prevalence and identification of risk factors for hospitalization can help providers improve care and reduce unnecessary referrals to hospitals. The characteristics above, associated with higher rates of hospitalization, could lead to improved education and better treatment protocols. That could improve patient care and over time, and reduce the cost of care.

Patients hospitalized with a primary diagnosis of AD, generally for eczema, were significantly younger than those without that primary diagnosis. Children were hospitalized for AD more often between ages 2 and 11 but less often between ages 12 to 17. The study models found that the proportion of adults hospitalized for atopic dermatitis decreased with age.2

Regardless of geographic location, the studies show that inpatient treatment and length of stay occurred at significantly higher rates in adults and children with nonwhite race/ethnicity, patients with Medicaid or no insurance, and lower household income and educational levels.2

Costs Associated with AD

The length of stay and associated costs of hospitalization were demonstrably higher for those who had AD, even if that was not the primary diagnosis associated with the need for hospitalization. A higher frequency of pediatric emergency/urgent care visits contributes to the significant health care costs associated with AD. Hospitalization rates are higher in the northeast during the winter and the south during the summer.3

The costs are not just medical. There are costs associated with home treatment of the condition and time away from work for those who either have, or take care of, someone with AD. Poor skin disease control can have numerous causes. Some report the inability to get a timely doctor’s appointment or being unable to arrange transportation. Others can’t afford their medications. Any of these reasons could increase the likelihood of hospitalization.

There appear to be significant racial, ethnic, and socioeconomic disparities between patients hospitalized with AD as opposed to without AD. Some of these findings may reflect that certain groups may more frequently use the hospital or ED as their main source of medical care. Without a primary care doctor, many people may have limited access to specialists including office-based dermatological care.2 Understanding the numerous disparities in approaching care should assist the medical community, the insurers, and patient population to work together to find solutions. Physicians might be able to better craft a plan of care by addressing individual patient circumstances while educating patients to become more efficient about choosing solutions and complying with care instructions when addressing AD needs.

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