Increased Healthcare Utilization Recorded in Patients with Concomitant AD and Asthma

Zarqa Ali, MD, PhD

New data from a nationwide cohort study suggested that improvements in care for adult patients with atopic dermatitis (AD) and asthma were needed, as these patients had different patterns of healthcare utilization compared to adults with AD or asthma alone.

These revisions in management and monitoring could reduce the number of unscheduled health care visits and lower healthcare costs, suggested an investigative team led by Zarqa Ali, MD, PhD, from the Department of Dermato-Venereology and Wound Healing Center at Copenhagen University Hospital in Denmark.

Previous research had suggested that the risk of healthcare utilization and medication drug use for asthma 1 year following diagnosis was significantly higher in children with concomitant AD and asthma compared to those with only asthma.

In addition to investigation differences in healthcare utilization among these patient groups, Ali and colleagues also evaluated the differences in contacts to general practitioners, psychiatrists, and psychologists for anxiety or depression.

The team culled data from the Danish Civil Registration System (CPR), which contained data from all inpatient and outpatient contacts across all Danish hospitals. Danish adults were identified for the CPR from January 1, 2005-December 31, 2018.

Eligible patients with AD and/or asthma were age- and sex-matched with a background population of people without either diagnosis in a 1:4 ratio.

All health care utilization data were culled in 3-month intervals from 2 years prior to the first diagnosis and 5 years after.

Overall, 12,409 patients with AD were included. Among them, 11,590 only had AD and 819 had concomitant AD and asthma, while 65,539 had asthma only.

Notably, the highest percentage of patients in the lowest socioeconomic status group consisted of concomitant AD and asthma (36%), following by those with AD only (27%), asthma only (18%), and patients in the control group (19%).

Overall, patients with concomitant AD and asthma had a higher risk of hospitalization for both AD (OR 1.38, 95% CI 1.15-1.67) (P=0.001) and asthma (OR 1.16, 95% CI 1.00-1.35) (P=0.047), respectively.

Patients affected by both conditions also experienced fewer visits to outpatient clinics for AD (OR 0.10, 95% CI 0.08-0.12), (P<0.001) andasthma(OR 0.34, 95% CI 0.29-0.39) (<0.001) compared to these groups, as well. However, outpatient clinic visits regarding rhinitis were more prevalent in those with concomitant conditions.

Ali and colleagues wrote of the “general fluctuation” observed in the risk of urgent healthcare use, emergency room visits, and more among patients with concomitant AD and asthma. These patients were often treated by GPs or private specialists as opposed to outpatient clinics, a pattern the team found particularly notable.

“A better understanding of the disease severity and interplay between atopic diseases along with in-depth understanding of the high need for emergency care is warranted,” they wrote.

The study, "Adults with concomitant atopic dermatitis and asthma have more frequent urgent health care utilization and less frequent scheduled follow-up visits than adults with atopic dermatitis or asthma only: A nationwide cohort study," was published online in JEADV.