Patterns and trends in eczema management in UK primary care (2009–2018): A population-based cohort study

TY - JOUR

T1 - Patterns and trends in eczema management in UK primary care (2009–2018)

T2 - A population-based cohort study

AU - de Lusignan, Simon

AU - Alexander, Helen

AU - Broderick, Conor

AU - Dennis, John

AU - McGovern, Andrew

AU - Feeney, Clarie

AU - Flohr, Carsten

PY - 2020

Y1 - 2020

N2 - Background: Despite the high disease burden of eczema, a contemporary overview of the patterns and trends in primary care healthcare utilization and treatment is lacking. Objective: To quantify primary care consultations, specialist referrals, prescribing, and treatment escalation, in children and adults with eczema in England. Methods: A large primary care research database was used to examine healthcare and treatment utilization in people with active eczema (n = 411,931). Management trends and variations by age, sex, socioeconomic status, and ethnicity were described from 2009 to 2018 inclusive. Results: Primary care consultation rates increased from 87.8 (95% confidence interval [95% CI] 87.3–88.3) to 112.0 (95% CI 111.5–112.6) per 100 person-years over 2009 to 2018. Specialist referral rates also increased from 3.8 (95% CI 3.7–3.9) to 5.0 (95% CI 4.9–5.1) per 100 person-years over the same period. Consultation rates were highest in infants. Specialist referrals were greatest in the over 50s and lowest in people of lower socioeconomic status, despite a higher rate of primary care consultations. There were small changes in prescribing over time; emollients increased (prescribed to 48.5% of people with active eczema in 2009 compared to 51.4% in 2018) and topical corticosteroids decreased (57.3%–52.0%). Prescribing disparities were observed, including less prescribing of potent and very potent topical corticosteroids in non-white ethnicities and people of lower socioeconomic status. Treatment escalation was more common with increasing age and in children of non-white ethnicity. Conclusion and clinical relevance: The management of eczema varies by sociodemographic status in England, with lower rates of specialist referral in people from more-deprived backgrounds. There are different patterns of healthcare utilization, treatment, and treatment escalation in people of non-white ethnicity and of more-deprived backgrounds.

AB - Background: Despite the high disease burden of eczema, a contemporary overview of the patterns and trends in primary care healthcare utilization and treatment is lacking. Objective: To quantify primary care consultations, specialist referrals, prescribing, and treatment escalation, in children and adults with eczema in England. Methods: A large primary care research database was used to examine healthcare and treatment utilization in people with active eczema (n = 411,931). Management trends and variations by age, sex, socioeconomic status, and ethnicity were described from 2009 to 2018 inclusive. Results: Primary care consultation rates increased from 87.8 (95% confidence interval [95% CI] 87.3–88.3) to 112.0 (95% CI 111.5–112.6) per 100 person-years over 2009 to 2018. Specialist referral rates also increased from 3.8 (95% CI 3.7–3.9) to 5.0 (95% CI 4.9–5.1) per 100 person-years over the same period. Consultation rates were highest in infants. Specialist referrals were greatest in the over 50s and lowest in people of lower socioeconomic status, despite a higher rate of primary care consultations. There were small changes in prescribing over time; emollients increased (prescribed to 48.5% of people with active eczema in 2009 compared to 51.4% in 2018) and topical corticosteroids decreased (57.3%–52.0%). Prescribing disparities were observed, including less prescribing of potent and very potent topical corticosteroids in non-white ethnicities and people of lower socioeconomic status. Treatment escalation was more common with increasing age and in children of non-white ethnicity. Conclusion and clinical relevance: The management of eczema varies by sociodemographic status in England, with lower rates of specialist referral in people from more-deprived backgrounds. There are different patterns of healthcare utilization, treatment, and treatment escalation in people of non-white ethnicity and of more-deprived backgrounds.

KW - atopic dermatitis

KW - atopic eczema

KW - dermatology

KW - eczema

KW - epidemiology

KW - primary care

KW - treatment

UR - http://www.scopus.com/inward/record.url?scp=85096673398&partnerID=8YFLogxK

U2 - 10.1111/cea.13783

DO - 10.1111/cea.13783

M3 - Article

C2 - 33176023

AN - SCOPUS:85096673398

SN - 0954-7894

JO - Clinical and Experimental Allergy

JF - Clinical and Experimental Allergy

ER -