title: The burden of atopic dermatitis in US adults: results from the 2013 National Health and Wellness Survey.
abstract: OBJECTIVE
  To characterize comorbidities, health-related quality-of-life (HRQoL), productivity, and healthcare resource use in adults with atopic dermatitis (AD) relative to those without AD, and to evaluate the impact of patient-reported AD severity on these outcomes.
  
  
  METHODS
  Data were from the 2013 National Health and Wellness Survey (NHWS), which collected self-reported information on demographics, comorbidities, HRQoL (SF-36v2 Health Survey), productivity (Work Productivity and Impairment questionnaire [WPAI]), and healthcare utilization, which were weighted to the US general population. The AD cohort consisted of subjects who reported that they experienced AD within the past 12 months (n = 428), and the non-AD cohort included all subjects who did not report experiencing AD (n = 74,572); 366 AD subjects self-reported mild (n = 182) or moderate/severe (n = 184) disease. Univariable and multivariable analyses compared characteristics and outcomes between cohorts and between AD severity levels.
  
  
  RESULTS
  The AD cohort was younger than non-AD cohort (44.3 vs. 46.6 years; P = 0.0033), and had a higher proportion of females (64.4% vs. 51.8%; P < 0.0001). Relative to the non-AD cohort, the AD cohort had a significantly higher prevalence of atopic conditions including nasal allergies (46.4% vs. 19.8%) and asthma (22.4% vs. 7.9%), and neuropsychiatric conditions such as anxiety (42.5% vs. 21.3%) and depression (37.2% vs. 20.9%) (all P < 0.0001). Units of resource use (healthcare practitioner visits, emergency room, hospitalizations) were higher (all P < 0.05) and HRQoL was poorer (P < 0.0001) with AD. On the WPAI, AD employees reported almost twice as much lost work productivity as non-AD employees (30.0% vs. 16.3%; P < 0.0001). No clear differences in outcomes were observed among patient-reported AD severity categories, except greater impairment of work productivity and daily activities in those with moderate/severe AD relative to mild.
  
  
  CONCLUSIONS
  The significant burden associated with AD relative to those without AD suggests an unmet need for more effective management strategies. There also appears to be a need for further characterization of disease severity and its impact on HRQoL.
authors.affiliation: a Pfizer Inc. , New York , NY , USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Whiteley
authors.affiliation: a Pfizer Inc. , New York , NY , USA.
authors.forename: Birol
authors.initials: B
authors.lastname: Emir
authors.affiliation: a Pfizer Inc. , New York , NY , USA.
authors.forename: Robin
authors.initials: R
authors.lastname: Seitzman
authors.affiliation: a Pfizer Inc. , New York , NY , USA.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Makinson
keywords: Atopic dermatitis; burden of illness; health care resource utilization; health related quality of life