Minority Children More Likely to Miss School Due to Atopic Dermatitis

By Marilynn Larkin

June 04, 2019

NEW YORK (Reuters Health) - Hispanic and non-Hispanic black children were significantly more likely to miss school because of atopic dermatitis compared with non-Hispanic white children, in a recent cross-sectional study.

Dr. Junko Takeshita of the University of Pennsylvania in Philadelphia and colleagues studied data on 8,015 children enrolled in a pediatric eczema registry between 2004-2017. At baseline, children had a median age of 6.6 years; 53% were girls; 50.9% identified as non-Hispanic black, 32.1% as non-Hispanic white, and 10.6% as Hispanic.

In addition to demographic characteristics, the children or their parents provided information on medical conditions, atopic dermatitis history and treatment, number of school days missed due to atopic dermatitis in the previous six months, and atopic dermatitis control.

As reported online May 22 in JAMA Dermatology, annual household income differed across racial/ethnic groups, with a greater proportion of non-Hispanic black and Hispanic children living in households with incomes below $50,000.

Overall, 60.3% of children used topical steroids in the six months prior to registry enrollment, and black and Hispanic children were more likely to report uncontrolled atopic dermatitis.

Among the 7,272 children enrolled in school or day care, 3.3% missed six or more days in the previous six months. Compared with non-Hispanic white children, non-Hispanic black and Hispanic children had higher adjusted odds of having at least six school absences (adjusted odds ratios, 1.49 and 3.4, respectively).

Factors significantly associated with six or more absences were: younger age (aOR, 0.95); household income between $50 000 and $99 999 (aOR, 0.55); uncontrolled atopic dermatitis (aOR, 6.36); longer duration of atopic dermatitis (aOR, 1.07); and comorbid asthma (aOR, 1.78) or allergic rhinitis (aOR, 2.03).

"Our study did not directly evaluate the reasons behind the differences in school attendance due to atopic dermatitis across racial/ethnic groups," Dr. Takeshita noted in an email to Reuters Health. "Thus, it is difficult to speculate on what actions would help to improve school attendance among those kids with atopic dermatitis who are most at risk."

"However, other work that we and others have done in psoriasis found that racial/ethnic minorities report larger quality of life impact from their skin disease compared to whites," she said. "So, I might hypothesize that atopic dermatitis also has a greater quality-of-life impact among minority versus children, but this study has not yet been done."

"If this proves to be the case," she said, "I might posit that this is one possible mechanism - i.e., quality of life impact - that contributes to different school attendance effects across racial/ethnic groups of children with atopic dermatitis."

"Ultimately, it is important to diagnose and appropriately treat all children with atopic dermatitis, which includes a timely referral to a dermatologist for more severe cases," she stressed. "It is also important for medical providers to ask children with atopic dermatitis and their families how the skin disease is affecting their everyday lives, beyond the directly associated symptoms, in order to minimize the overall impact of this chronic skin disease on people's lives."

Dermatologist Dr. William W. Huang, Associate Professor and Residency Program Director at Wake Forest School of Medicine in Winston-Salem, North Carolina, commented by email, "The authors point out several limitations of their cross-sectional study, including the use of self-reported data, residual unmeasured confounding factors, and too few outcomes in the other racial groups to draw an inference. They did try and control for sociodemographic factors, atopic dermatitis disease control, health care visits, and atopic comorbidities."

"Beyond these, there are likely unmeasured and poorly understood social, economic, and cultural factors that this study does not capture," he told Reuters Health. "As noted in other chronic skin diseases, there is an observed disparity. A more thorough understanding of these factors can help providers be better attuned to their patients and perhaps more culturally sensitive to all patient populations."

SOURCE: http://bit.ly/2EM4h5v

JAMA Dermatol 2019.