Abstract
This cross-sectional study of National Health Interview Survey data examines differences among sociodemographic subgroups in reported incidence of eczema in children in the US.
Research on the prevalence of eczema in children in the US is limited; surveys suggest that disparities in care may exist between sociodemographic subgroups.1 We investigated the prevalence of eczema in children in the US from 1997 to 2018 by sociodemographic subgroup.
Methods
This cross-sectional study used data from the US National Health Interview Survey from 1997 to 2018.2 All respondents or their parent or guardian provided informed oral consent. The survey was approved by the Health Interview Survey Institutional Review Board of the National Center for Health Statistics, Centers for Disease Control and Prevention. A specific question was asked to determine the prevalence of eczema or skin allergy during the past 12 months. The STROBE reporting guideline was followed. We included children aged 0 to 17 years and calculated the survey-weighted eczema prevalence in the previous 12 months from the overall sample and subgroups of age (0-5, 6-10, and 11-17 years); sex (male, female); race (American Indian or Alaskan Native, Asian, Black, multiracial, White); and Hispanic ethnicity (yes, no) using SPSS version 26 (IBM Corporation) complex sample module. Race and ethnicity were recorded from the survey instrument. We used the joinpoint regression model to estimate piecewise log-linear trends in the survey-weighted prevalence of eczema in the total and stratified samples.3 The annual percentage change (APC) was estimated for each segment and the average APC (AAPC) for the entire period. Differences in AAPCs between 2 subgroups were estimated using parallel pairwise comparisons.4 The 2-sided P < .05 was considered significant.
Results
Of 260 888 children in the National Health Interview Survey, most were aged 11 to 17 years (39.2%), male (51.1%), and White (75.1%). The prevalence of eczema in the sample increased from 7.9% in 1997 to 12.6% in 2018, and joinpoint regression identified an increasing prevalence trend from 1997 to 2010, after which the prevalence remained stable (Table).
Table. Survey-Weighted Prevalence of Eczema and Joinpoint Trends in Children in the US by Sociodemographic Subgroup From 1997 to 2018.
| Sociodemographic subgroup | Unweighted count (weighted %) | Prevalence of eczema, % (95% CI) | AAPC, 1997-2018, % (95% CI) | Segment 1a | APC, % (95% CI) | Segment 2a | APC, % (95% CI) | |
|---|---|---|---|---|---|---|---|---|
| 1997 | 2018 | |||||||
| Total sample | 260 888 (100) | 7.9 (7.3 to 8.5) | 12.6 (11.6 to 13.6) | 2.8b (1.8 to 3.8) | 1997-2010 | 4.1b (2.9 to 5.3) | 2010-2018 | 0.6 (−1.5 to 2.8) |
| Age categories, y | ||||||||
| 0-5 | 88 523 (33.0) | 8.1 (7.2 to 9.1) | 13.7 (12.1 to 15.5) | 2.8b (1.8 to 3.8) | 1997-2010 | 4.6b (3.4 to 5.9) | 2010-2018 | −0.1 (−2.2 to 2.0) |
| 6-10 | 67 074 (27.8) | 7.8 (6.7 to 9.0) | 12.6 (11.0 to 14.3) | 2.9b (1.9 to 4.0) | 1997-2010 | 4.7b (3.4 to 6.0) | 2010-2018 | 0.2 (−2.0 to 2.4) |
| 11-17 | 105 291 (39.2) | 7.8 (7.0 to 8.7) | 11.6 (10.4 to 12.9) | 2.6b (2.0 to 3.2) | 1997-2018 | 2.6b (2.0 to 3.2) | NA | NA |
| Sex | ||||||||
| Male | 134 196 (51.1) | 7.7 (7.0 to 8.5) | 12.2 (11.0 to 13.6) | 2.7b (1.8 to 3.7) | 1997-2011 | 4.1b (3.1 to 5.1) | 2011-2018 | 0.0 (−2.3 to 2.4) |
| Female | 126 692 (48.9) | 8.1 (7.3 to 9.0) | 12.9 (11.6 to 14.3) | 2.8b (2.2 to 3.5) | 1997-2018 | 2.8b (2.2 to 3.5) | NA | NA |
| Racec | ||||||||
| American Indian or Alaskan Native | 2804 (1.1) | 3.4 (1.3 to 8.5) | 6.5 (3.2 to 12.8) | 2.6 (−0.9 to 6.2) | 1997-2018 | 2.6 (−0.9 to 6.2) | NA | NA |
| Asian | 12 314 (4.2) | 11.1 (8.0 to 15.3) | 11.5 (8.8 to 14.8) | 2.6b (1.1 to 4.1) | 1997-2018 | 2.6b (1.1 to 4.1) | NA | NA |
| Black | 41 157 (14.9) | 10.1 (8.6 to 11.8) | 18.4 (15.4 to 21.8) | 3.5b (1.8 to 5.1) | 1997-2011 | 5.2b (3.7 to 6.9) | 2011-2018 | −0.0 (−4.1 to 4.3) |
| Multiracial | 15 374 (4.7) | 9.7 (7.3 to 12.7) | 16.7 (13.1 to 21.0) | 3.9b (1.8 to 6.0) | 1997-2009 | 6.4b (3.5 to 9.4) | 2009-2018 | 0.6 (−2.8 to 4.1) |
| White | 189 042 (75.1) | 7.3 (6.7 to 8.0) | 11.3 (10.3 to 12.4) | 2.5b (1.9 to 3.1) | 1997-2018 | 2.5b (1.9 to 3.1) | NA | NA |
| Hispanic ethnicityc | ||||||||
| Yes | 72 609 (20.8) | 5.6 (4.7 to 6.6) | 10.6 (9.0 to 12.4) | 2.5b (1.9 to 3.1) | 1997-2018 | 3.9b (3.0 to 4.7) | NA | NA |
| No | 188 251 (79.2) | 8.3 (7.7 to 9.0) | 13.2 (12.1 to 14.4) | 2.7b (1.7 to 3.8) | 1997-2010 | 4.0b (2.9 to 5.2) | 2010-2018 | 0.7 (−1.5 to 2.8) |
Abbreviations: AAPC, average annual percentage change; APC, annual percentage change.
Segments were chosen by joinpoint regression.
Results are statistically significant.
Race and Hispanic ethnicity were recorded from the survey instrument (US National Health Interview Survey). There were 197 and 28 missing values in race and Hispanic ethnicity variables.
The prevalence in all age groups increased from 1997 to 2010, but only the prevalence in the 11 to 17 years age group increased for the entire study period (Figure). The prevalence of eczema in males increased from 1997 to 2011 and then remained stable. The trend increased for the entire period in females. Increasing trends were seen in White and Asian children in the prevalence of eczema for the entire study period. The prevalence in Black children increased until 2011 and in multiracial children until 2009. The AAPC of the prevalence in White children was lower than the AAPC of Black (difference, −0.9% [95% CI, −2.7% to 0.8%]; P = .01) and multiracial children (difference, −1.3% [95% CI, −3.5% to 0.8%]; P = .04). An increasing trend in the prevalence of eczema was observed in Hispanic children from 1997 to 2018; the prevalence increased only from 1997 to 2010 in non-Hispanic children.
Figure. Prevalence of Eczema Among Children in the US From 1997 to 2018 by Subgroup.
APC indicates annual percentage change.
Discussion
This study found an increasing trend in the prevalence of eczema from 1997 to 2018 for noninstitutionalized children in the US with significant differences between race and ethnicity. Specifically, larger yearly AAPCs in children with eczema in Black and multiracial subgroups (compared with White) were identified. Regarding study limitations, the prevalence of eczema was caregiver-reported and not based on diagnostic testing, and some subgroups, such as American Indian or Alaskan Native, had low sample sizes.
These findings suggest changes in the diagnosing of eczema among racial and ethnic minority groups.5 In a 2019 study,6 African genetic ancestry was not associated with 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. However, more research among pediatric racial and ethnic minority populations is warranted.
Data Sharing Statement
References
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Supplementary Materials
Data Sharing Statement
