BACKGROUND Despite the high disease burden of eczema, a contemporary overview of the patterns and trends in UK primary care healthcare utilisation and treatment is lacking. OBJECTIVE To quantify primary care consultations, specialist referrals, prescribing, and treatment escalation, in children and adults with eczema in England. METHODS A large primary care research database was used to examine healthcare and treatment utilisation in people with active eczema (n=411,931). Management trends and variations by age, sex, socioeconomic status, and ethnicity were described from 2009-2018 inclusive. RESULTS Primary care consultation rates increased from 87.8 (95% confidence interval [95%CI] 87.3-88.3) to 112.0 (95%CI 111.5-112.6) per 100 person-years over 2009 to 2018. Specialist referral rates also increased from 3.8 (95%CI 3.7-3.9) to 5.0 (95%CI 4.9-5.1). Consultation rates were highest in infants. Specialist referrals were greatest in the over 50s and lowest in people of lower socioeconomic status, despite the highest rates of primary care consultations. There were small changes in prescribing over time; emollients increased (prescribed to 48.5% of people with active eczema in 2009 compared to 51.4% in 2018) and topical corticosteroids decreased (57.3% to 52.0%). Prescribing disparities were observed, including less prescribing of potent and very potent topical corticosteroids in non-white ethnicities and people of lower socioeconomic status. Treatment escalation was more common with increasing age and in children of non-white ethnicity. CONCLUSION AND CLINICAL RELEVANCE The management of eczema varies by sociodemographic status in England, with lower rates of specialist referral in people from more deprived backgrounds. There are different patterns of healthcare utilisation, treatment, and treatment escalation in people of non-white ethnicity and of more deprived backgrounds.

中文翻译：

---

英国初级保健中湿疹管理的模式和趋势（2009-2018）：一项基于人群的队列研究

背景尽管湿疹的疾病负担很高，但缺乏对英国初级保健医疗保健利用和治疗的模式和趋势的当代概述。目的 量化英格兰儿童和成人湿疹患者的初级保健咨询、专家转诊、处方和治疗升级。方法 大型初级保健研究数据库用于检查活动性湿疹患者 (n=411,931) 的医疗保健和治疗利用情况。描述了 2009 年至 2018 年（含）的年龄、性别、社会经济地位和种族的管理趋势和变化。结果 初级保健咨询率从 2009 年到 2018 年每 100 人年的 87.8（95% 置信区间 [95%CI] 87.3-88.3）增加到 112.0（95%CI 111.5-112.6）。专科转诊率也从 3.8（95%CI 111.5-112.6）增加到95%CI 3.7-3.9) 到 5.0 (95%CI 4.9-5。1）。婴儿的就诊率最高。尽管初级保健咨询率最高，但专家转诊在 50 多岁的人群中最多，在社会经济地位最低的人群中最少。随着时间的推移，处方有微小的变化；润肤剂增加（2009 年有 48.5% 的活动性湿疹患者使用，而 2018 年为 51.4%），外用皮质类固醇减少（57.3% 到 52.0%）。观察到了处方差异，包括在非白人种族和社会经济地位较低的人群中处方较少的强效和非常强效的局部皮质类固醇。随着年龄的增长和非白人种族的儿童，治疗升级更为常见。结论和临床相关性 湿疹的治疗因英格兰的社会人口状况而异，来自更贫困背景的人的专家转诊率较低。非白人种族和贫困背景的人群在医疗保健利用、治疗和治疗升级方面存在不同的模式。