Atopic dermatitis in an urban adult population: identifying the role of social and environmental factors

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ABSTRACT Atopic dermatitis (AD) is a common, chronic inflammatory disease of the skin that affects 10% of adults. AD is associated with major health-related quality-of-life (QoL) and psychosocial impairments that exceed those of other serious chronic diseases such as heart disease, diabetes, and hypertension. Despite the major physical and emotional burdens that accompany AD, it remains an understudied skin disease among adults because, until recently, AD had been incorrectly considered a childhood disease that remits in adulthood. Importantly, our preliminary data reveal racial/ethnic differences in the severity of, QoL impact of, and health care utilization for AD that suggest the presence of disparities in AD outcomes that deserve further study. Considering the anticipated diversification of the U.S. population, such disparities are only expected to worsen if left unaddressed. However, a critical barrier to identifying, understanding, and ultimately eliminating racial/ethnic disparities in AD outcomes among adults exists due to the lack of adult AD cohorts with sufficient racial/ethnic diversity and individual-level social and environmental contextual data that are necessary to comprehensively evaluate the causes of such disparities. In order to address this barrier, we propose to create a cohort of racially and ethnically diverse adults with AD within the socioeconomically disadvantaged and medically underserved, urban neighborhood of North Philadelphia, Pennsylvania. North Philadelphia adult residents represent a population that is vulnerable to a large burden of AD. With this cohort, we aim to perform a longitudinal cohort study to: i) confirm and further characterize existing racial/ethnic disparities in AD outcomes and health care utilization for AD among adults, and ii) identify the individual behavioral, social, and environmental contextual factors that simultaneously contribute to racial/ethnic disparities in AD outcomes. We will address these aims utilizing a novel transdisciplinary approach and a sequential mixed methods study design in order to incorporate the lived experience of adults with AD in our studies. We hypothesize that specific and potentially modifiable behavioral, social, and environmental factors contribute to racial/ethnic disparities in AD outcomes. The new knowledge that will be gained from the proposed work is essential to informing future individual- and community-level interventions to reduce racial/ethnic disparities and improve AD outcomes among similar urban adult populations.