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Associations of Childhood Eczema Severity: A US Population-Based Study

Silverberg, Jonathan I. MD, PhD, MPH*†‡; Simpson, Eric L. MD, MCR§

doi: 10.1097/DER.0000000000000034

Background Little is known about the predictors of eczema severity in the US population.

Objectives We sought to determine the distribution and associations of childhood eczema severity in the United States.

Methods We analyzed the data from the 2007 National Survey of Children’s Health, a prospective questionnaire-based study of a nationally representative sample of 91,642 children (range, 0–17 years).

Results The prevalence of childhood eczema was 12.97% (95% confidence interval [95% CI], 12.42–13.53); 67.0% (95% CI, 64.8–69.2) had mild disease, 26.0% (95% CI, 23.9–28.1) had moderate disease, and 7.0% (95% CI, 5.8–8.3) had severe disease. There was significant statewide variation of the distribution of eczema severity (Rao-Scott χ2, P = 0.004), with highest rates of severe disease in Mid-Atlantic and Midwestern states. In univariate models, eczema severity was increased with older age, African American and Hispanic race/ethnicity, lower household income, oldest child in the family, home with a single mother, lower paternal/maternal education level, maternal general health, maternal/paternal emotional health, dilapidated housing, and garbage on the streets. In multivariate survey logistic regression models using stepwise and backward selection, moderate-to-severe eczema was associated with older age, lower household income, and fair or poor maternal health but inversely associated with birthplace outside the United States.

Conclusions These data indicate that environmental and/or lifestyle factors play an important role in eczema severity.

From the Departments of *Dermatology, †Preventive Medicine, and ‡Medical Social Sciences, Northwestern University, Chicago, IL; and §Department of Dermatology, Oregon Health and Sciences University, Portland, OR.

Address reprint requests to Jonathan I. Silverberg, MD, PhD, MPH, Department of Dermatology, Northwestern University, Suite 1400, 680 Lake Shore Dr, Chicago, IL 60611. E-mail:

Statistical analysis was conducted by JI Silverberg.

This project was supported in part by a Mentored Patient-Oriented Research Career Development Award (K23) with award number K23AR057486 for Eric Simpson from the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health.

The authors have no conflicts of interest to declare.

© 2014 American Contact Dermatitis Society
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