Capture of Patient Itch Scores in Practice Reveals Disparate Itch Impact on the Basis of Age, Gender, and Race: A Cross-Sectional Survey Analysis

Abstract

Background: Skin symptom burden, varying with patient populations, may not be readily observed by clinicians, resulting in incomplete appreciation of total skin disease burden.

Objective: The purpose of this study was to define patient itch burdens and associated health-related QOL affecting different patient demographics and to identify potential population health disparities.

Methods: This is a cross-sectional, secondary data analysis of data captured using an automated routine electronic previsit survey completed by patients who visited Emory Healthcare Dermatology clinic between March 2021 and October 2022 (6532 patient visits). Descriptive statistics and ordered logit regression analyses were used to examine the prevalence and intensity of itch and the impacts of itch on QOL.

Results: Overall itch burden increases as age increases; females and African Americans experienced more itch burden than males and other racial groups. Itch places significant symptom, emotional, and functional burdens on patients' QOL, impacts that are independent of patients' demographics.

Limitations: The data collected were from a single dermatology practice and may not be reflective of other practices or populations.

Conclusion: Dermatology previsit surveys are feasible in examining the significant pruritus burden, especially for older individuals, females, and African Americans with chronic skin conditions.

Keywords: Age; Automation; Data collection; Gender; General dermatology.

Figure 1

Itch severity by age. The percentage of age cohorts reporting little or no itch declined gradually from over 70% in the youngest cohort to 60% in those aged ≥75 years. The prevalence of patients reporting severe itching saw an almost 4-fold increase in the older age cohorts, escalating from 3.4% in the group aged 18–25 years to nearly 13.0% in cohorts aged ≥45 years.

Figure 2

Itch severity by gender. More females reported severe itch than males.

Figure 3

Itch severity by race. A higher percentage of African American patients experienced severe itch than other groups, and a lower percentage reported no itching.

Figure 4

Itch severity by primary patient concern. Patients responding to the previsit survey are given choices for their primary skin concern, which include the choices of skin appearance, skin symptoms, worry that something else might be happening, or other symptoms. Patients who reported skin symptoms as their primary concern experienced moderate-to-severe itch more frequently than patients concerned with skin appearance.

Figure 5

Itch severity by patient-reported primary skin problem. Patients responding to the previsit survey are given choices for the primary reason for their visit, which included acne, itching, rash, hair problem, birthmark/hemangioma, nail problems, hidradenitis, or an option for free text response (unclassified).