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

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 χ, 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.