Examining racial and ethnic disparities in diagnosis and access to care in infantile atopic dermatitis in the USA: a retrospective cohort study.

Abstract

Background: Atopic dermatitis (AD) is an inflammatory skin disorder that is common in children and associated with medical and psychosocial comorbidities. Previous studies have shown that there are significant racial disparities in healthcare utilization in children with AD; however, the literature on disparities in dermatology access is limited.

Objectives: To identify differences in the diagnosis of AD and access to dermatological care by race and ethnicity in infants with AD.

Methods: We conducted a retrospective chart review of infants diagnosed with AD at Boston Children's Hospital from 1 January 2015 to 31 December 2019. Race and ethnicity were categorized as per the US Office of Minority Health data collection standards as Native American or Alaska Native; Asian; non-Hispanic Black or African American; Hispanic or Latino; Native Hawaiian or Other Pacific Islander; non-Hispanic White; and a final group which we called 'Other' (this encompassed all individuals who did not identify with the other groups listed). Outcomes included time to diagnosis and dermatology visit from rash onset, and were analysed utilizing a Kruskal-Wallis test. Severity of presentation at first dermatology visit, presentation to the emergency department (ED), medications prescribed and follow-up were analysed using χ 2 tests.

Results: Significantly more non-Hispanic White infants received a prescription from their paediatrician for AD than Hispanic infants (P = 0.002). Non-Hispanic Black and Asian infants waited significantly longer to see a dermatologist after receiving a prescription for AD from their paediatrician (P < 0.001) compared with non-Hispanic White patients (P = 0.007). Significantly more non-Hispanic Black and Hispanic infants presented to the ED for AD within the first year of life (P < 0.001) than non-Hispanic White patients (P = 0.003).

Conclusions: Our study suggests disparities in diagnosis and access to care for non-Hispanic Black and Hispanic infants with AD, with differences in prescriptions, time to see a dermatologist and presentation to the ED vs. non-Hispanic White infants.