Itch as a patient-reported symptom in ambulatory care visits in the United States

Abstract

Background: European studies have shown that itch is a widespread symptom, yet little is known about its frequency in the United States.

Objective: We sought to describe ambulatory care visits to clinicians in the United States for which itch was coded as a patient symptom.

Methods: This study uses retrospective data from the National Ambulatory Medical Care Survey from 1999 through 2009.

Results: Itch was coded as a symptom for an average of 7 million visits per year or approximately 1% of all outpatient visits, which was nearly 40% of the number of visits for the symptom of low back pain. Patients seen in visits for itch were more likely to be black or Asian than other patients (20% vs 14%). They were also more likely than other patients to receive a new medication (68% vs 36%) and were over twice as likely to receive 2 or more new medications (31% vs 14%).

Limitations: Secondary data sets may not optimally capture patient reports and some of the procedures or medications may have been ordered for reasons other than itch.

Conclusion: Visits to clinicians for itch represent a sizeable proportion of ambulatory care visits in the United States, and research on the epidemiology, treatments, and causes of itch should be a priority.

Keywords: National Ambulatory Medical Care Survey; clinic; clinic visits; epidemiology; itch; outpatient; pruritus; quality of life; skin.

Figure 1

Annual Number of Visits for Itch per 1000 People by Patient Age and Sex

Figure 2

Annual Number of Visits for Itch per 1000 People by Patient Age and Race Abbreviations: AA, African American; NH, Native Hawaiian; PI, Pacific Islander. Certain data points for Black/AA and Asian/NH/PI are not shown because there were too few observations to draw reliable estimates. Two racial groups, “American Indian/Alaskan Native” and “More than one race,” are not shown because of inadequate numbers of observations.

Figure 3

Plans for Follow-up after Visits for Itch by Clinician Specialty^{a a} No follow-up includes: no follow-up, return as needed, and no disposition recorded (<3% of all visits). Other disposition includes: returned to referring physician, telephone follow-up, referred to the ED, admitted to hospital, and others.