Pediatric Resident PGY-2 Nemours Children's Hospital Orlando, Florida, United States
Background: Atopic dermatitis (AD) is one of the most common chronic childhood conditions. Racial and ethnic healthcare disparities affecting Black or African American patients with AD have been described, but data on the Hispanic population is sparse. Disparities in treatment and access to care can result in poor disease control and decreased quality of life. Objective: This study aimed to evaluate racial and ethnic disparities in treatment and healthcare utilization in pediatric AD in Central Florida, with an emphasis on the Hispanic population. Design/Methods: This retrospective descriptive study identified 4008 children 0-17 years of age within the Nemours Children’s Health Central Florida electronic medical record with confirmed AD from January 2016 to February 2019. Healthcare utilization was assessed for 18 months following the initial visit, using the number of visits with a main diagnosis of AD. The secondary endpoint was the number of AD-related prescriptions. Multivariable models were used to compare racial and ethnic groups (Black, Hispanic, Asian, and other) to the reference group of non-Hispanic White (NHW) while adjusting for age at first visit, gender, insurance, and presence of atopic comorbidities. Results: Among the patients studied, 36.4% identified as NHW, 33.9% Hispanic, 17.5% Black, 3.2% Asian, and 9% other race. Results are seen in Table 1. The mean number of urgent care visits for the Hispanic group was 1.61 times that of the NHW group and emergency department (ED) visits were 3.71 (p < 0.001). Black or African American patients had a mean number of ED visits 1.52 times that of NHW patients (p=0.021). The mean count of primary care visits among Hispanic patients was 0.77 times that of the NHW group (p < 0.001) and 1.28 times among Asian patients (p=0.012). Visits to subspecialty clinics and hospitalizations did not differ significantly. Patients in the other race category had significantly more prescriptions for non-steroidal AD medications. There were no other statistically significant differences in prescriptions between racial and ethnic groups.
Conclusion(s): Among pediatric patients with AD, Hispanic patients had higher rates of ED and urgent care visits and lower rates of primary care visits compared to NHW patients, with no consistent difference in treatment. Similar trends were seen to a lesser degree in ED visits among Black or African American patients, but not in other racial and ethnic groups. This study suggests higher healthcare utilization among Hispanic and Black or African American patients, concerning for Social Determinants of Health factors affecting access to care.
