573775 research-article2015

CMSXXX10.1177/1203475415573775Journal of Cutaneous Medicine & SurgeryDavis et al

Basic/Clinical Science Journal of Cutaneous Medicine and Surgery 1­–3 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1203475415573775 jcms.sagepub.com

Trends in Ambulatory Health Care Usage for Adult Acne Scott A. Davis1, Karen E. Huang1, Steven R. Feldman1,2,3, Alan B. Fleischer, Jr.1, and William W. Huang1

Abstract Background: The prevalence of acne is increasing among young children but not well characterized in older patients. Objective: To determine whether ambulatory health care for adult acne is increasing and whether the average age of adult acne patients seeking care has been increasing over time. Methods: We performed a retrospective analysis of data from the 1993-2010 National Ambulatory Medical Care Survey for acne visits in ages 25 and older. Results: Average age of adult acne patients increased by 0.13 years per year over the study period. Visits per 100 000 population declined in the 25 to 34 age group (P = .05) and did not change significantly in the 35 to 44 and 45 and older age groups. Conclusions: The hypothesis that adult acne visits are increasing was not supported, but the average age of adult acne patients seeking care has been rising. Résumé Contexte : La prévalence de l’acné augmente chez les jeunes enfants, mais elle n’est pas bien caractérisée chez les personnes âgées. Objectif : Déterminer si le nombre de consultations en soins ambulatoires motivées par l’acné de l’adulte augmente et si l’âge moyen des patients qui consultent pour acné de l’adulte augmente avec le temps. Méthodologie : Nous avons effectué une analyse rétrospective de données sur les consultations médicales motivées par l’acné chez les personnes de 25 ans et plus recueillies entre 1993 et 2010 au cours de la National Ambulatory Medical Care Survey (enquête nationale sur les soins médicaux ambulatoires). Résultats : L’âge moyen des patients atteints d’acné de l’adulte a augmenté de 0,13 an par année au cours de l’étude. Le nombre de consultations par 100 000 habitants a baissé dans le groupe des 25 à 34 ans (p = 0,05) et n’a pas changé de façon significative dans les groupes des 35 à 44 ans et des 45 ans et plus. Conclusions : L’hypothèse selon laquelle le nombre de consultations motivées par l’acné de l’adulte augmente n’est pas confirmée; en revanche, l’âge moyen des patients qui consultent pour acné de l’adulte augmente. Keywords age, NAMCS, middle age, female, prevalence, health care resources

Introduction

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Recently adult acne has been gaining increased attention. Acne seems to be increasing among young children,2,3 but it is unclear whether acne is actually increasing in prevalence among older age groups.2 The only study we found that collected data on changes in adult acne over a significant time period was a single-center study from England showing that the age of adult acne patients at their clinic increased from 20.5 to 26.5 over the period 1984 to 1994.4 Therefore, there appears to be a dearth of literature on this topic.

Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA 2 Department of Pathology, Wake Forest School of Medicine, WinstonSalem, NC, USA 3 Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA Corresponding Author: Scott A. Davis, MA, Department of Dermatology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1071, USA. Email: [email protected]

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Figure 1.  Average age of adult acne visits over time. Linear regression revealed that the average age of adult acne visits increased by 0.13 years per year over the period 1993-2010 (P = .04).

The purpose of this study was to test 2 hypotheses: that ambulatory health care for adult acne is increasing and that the average age of adult acne patients seeking care has been increasing over time.

Journal of Cutaneous Medicine and Surgery 

Figure 2.  Acne visits per 100 000 population by age range and year. Using a t test to compare the first 5 years to the last 5 years, the 25 to 34 age group saw a decline (P = .05), while the other groups showed no statistically significant change (P = .65 for ages 35-44, P = .61 for ages 45 and older). Population estimates are taken from the NAMCS documentation, which gives the total noninstitutionalized civilian population by age group based on US census data and postcensal estimates.

We used the 1993-2010 National Ambulatory Medical Care Survey (NAMCS) data to characterize visits with a first, second, or third acne diagnosis. The NAMCS collects data on outpatient ambulatory non–federally employed US physicians.5 We analyzed adult acne visits, defined as age ≥25. Since studies claim adult acne among women is increasing,1 we performed subanalyses on each gender. Census data, included in NAMCS documentation as noninstitutionalized civilian population, were used to calculate estimates per 100 000 population, and t tests were used to compare rates over time.6 Since it was not possible to perform regression on the number of visits per 100 000 population, we used a SAS macro to perform the t tests for the number of acne visits per 100 000 population in the first 5 years of the period (19931997) to the last 5 years (2006-2010). Other trends were assessed using the linear regression procedure SAS PROC SURVEYREG (SAS Institute, Cary, North Carolina, USA), with age as the dependent variable and year of visit as the independent variable. The study was declared exempt by the Wake Forest Baptist Hospital Institutional Review Board.

increased by 0.13 years per year (95% CI, 0.01-0.25) from 1993 to 2010, from about 36.5 to almost 39 (P = .04) (Figure 1). The number of visits per 100 000 population declined in all 3 of the age ranges 25 to 34, 35 to 44, and 45 and older (Figure 2), although only the 25 to 34 age group declined significantly (P = .05). When including only females, the average age increased by 0.14 years per year (95% CI, 0.010.26; P = .04), and visits per 100 000 in all 3 age ranges declined, but only the 25 to 34 age group declined significantly (P = .02, P = .49, P = .81 for ages 25-34, 35-44, and 45 and older, respectively). When including only males, the average age showed no significant change (β = 0.07 years per year; 95% CI, –0.20 to 0.35; P = .6), and visits per 100 000 in all 3 ranges showed no significant change (P = .57, P = .67, P = .99 for ages 25-34, 35-44, and 45 and older, respectively). The upward trend in age was significant for established patients (P = .03, β = 0.16 years/year) but not for new patients (P = .6, β = 0.06), who comprised a fairly constant share (21.6%) of all adult acne patients. Dermatologists saw 77.1% of patients, and the trend in average age was similar for patients of dermatologists (P = .04, β = 0.13) and nondermatologists (P = .4, β = 0.12).

Results

Discussion

There were 2025 unweighted records used to estimate the experience of 45 million adult acne visits (78.3% females). Average age was 37.7 years overall (95% CI, 37.1-38.3), 37.2 (95% CI, 36.6-37.8) for females, and 39.5 (95% CI, 38.0-40.9) for males. The average age of adult acne visits

The number of visits per 100 000 for adult acne is decreasing. The more substantial drop in the 25 to 34 and 35 to 44 age groups, compared to those over 45, largely explains the increasing average age of adult acne. Since the unit of analysis is the office visit, it is unclear whether the results indicate

Methods

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Davis et al a true decrease in prevalence, more self-management of acne without physicians, or fewer visits per patient due to more efficacious treatments. Since acne is the most common chronic treated skin condition in the US, requiring multiple visits, more efficient management of acne may liberate resources to address other skin problems. Future studies using population-wide representative data should be done to estimate precisely the trend in adult acne prevalence. Declaration of Conflicting Interests The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Feldman is a consultant and speaker for Galderma, Stiefel/ GlaxoSmithKline, Abbott Labs, Warner Chilcott, Janssen, Amgen, Photomedex, Genentech, BiogenIdec, and Bristol Myers Squibb. Dr Feldman has received grants from Galderma, Astellas, Abbott Labs, Warner Chilcott, Janssen, Amgen, Photomedex, Genentech, BiogenIdec, Coria/Valeant, Pharmaderm, Ortho Pharmaceuticals, Aventis Pharmaceuticals, Roche Dermatology, 3M, Bristol Myers Squibb, Stiefel/GlaxoSmithKline, Novartis, Medicis, Leo, HanAll Pharmaceuticals, Celgene, Basilea, and Anacor and has received stock options from Photomedex. Dr Feldman is the founder and holds stock in Causa Research. Dr Fleischer has received support for research, speaking, or consulting from Abbvie, Galderma, Regeneron, Eli Lilly, and Celgene and is employed by Merz Pharmaceuticals. Mr Davis, Ms Huang, and Dr Huang have no conflicts to disclose.

Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories, LP.

References 1. Kim GK, Michaels BB. Post-adolescent acne in women: more common and more clinical considerations. J Drugs Dermatol. 2012;11(6):708-713. 2. Bhate K, Williams HC. Epidemiology of acne vulgaris. Br J Dermatol. 2013;168(3):474-485. 3. Goldberg JL, Dabade TS, Davis SA, Feldman SR, Krowchuk DP, Fleischer AB. Changing age of acne vulgaris visits: another sign of earlier puberty? Pediatr Dermatol. 2011;28(6):645648. 4. Goulden V, Clark SM, Cunliffe WJ. Post-adolescent acne: a review of clinical features. Br J Dermatol. 1997;136(1):66-70. 5. Ahn CS, Allen MM, Davis SA, Huang KE, Fleischer AB J., Feldman SR. The National Ambulatory Medical Care Survey: a resource for understanding the outpatient dermatology treatment. J Dermatolog Treat. 2014;25(6):453-458. 6. National Center for Health Statistics. NAMCS/NHAMCS— questionnaires, datasets, and related documentation. http:// www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htm. Published January 17, 2014. Accessed June 9, 2014.

Trends in Ambulatory Health Care Usage for Adult Acne.

The prevalence of acne is increasing among young children but not well characterized in older patients...
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