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Little is known about the predictors of eczema severity in the US population.We sought to determine the distribution and associations of childhood eczema severity in the United States.We analyzed the data from the 2007 National Survey of Children’s Health, a prospective questionnaire-based study of a nationally representative sample of 91,642 children (range, 0–17 years).The prevalence of childhood eczema was 12.97% (95% confidence interval [95% CI], 12.42–13.53); 67.0% (95% CI, 64.8–69.2) had mild disease, 26.0% (95% CI, 23.9–28.1) had moderate disease, and 7.0% (95% CI, 5.8–8.3) had severe disease. There was significant statewide variation of the distribution of eczema severity (Rao-Scott χ2, P = 0.004), with highest rates of severe disease in Mid-Atlantic and Midwestern states. In univariate models, eczema severity was increased with older age, African American and Hispanic race/ethnicity, lower household income, oldest child in the family, home with a single mother, lower paternal/maternal education level, maternal general health, maternal/paternal emotional health, dilapidated housing, and garbage on the streets. In multivariate survey logistic regression models using stepwise and backward selection, moderate-to-severe eczema was associated with older age, lower household income, and fair or poor maternal health but inversely associated with birthplace outside the United States.These data indicate that environmental and/or lifestyle factors play an important role in eczema severity.