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.
Atopic dermatitis (also known as eczema) is a skin condition often seen in childhood. It can negatively affect the quality of life of children and their families. Many studies have shown that children belonging to minority ethnic groups are more affected by their eczema. There have been no studies of the effect of race and ethnicity on infants with eczema. Our study took place at Boston Children’s Hospital. We collected information about all infants who had an appointment for eczema. We categorized the children’s race and ethnicity. We looked at how severe the eczema was at their first dermatology appointment, if they received medication, if they had a follow-up appointment and if they attended the emergency room (‘ER’). We found that non-Hispanic White and Asian infants with eczema got more medication from their paediatrician than Hispanic infants with eczema. We also found that non-Hispanic Black infants had to wait longer to see a dermatologist after receiving eczema medication than non-Hispanic White infants. Non-Hispanic Black and Hispanic infants went to the ER for eczema treatment more often than non-Hispanic White infants. Our study suggests there could be differences in how non-Hispanic Black and Hispanic infants are treated for eczema. This could be due to difficulty recognizing eczema in darker skin tones and communication barriers. Our findings show the need to improve healthcare access for infants from minority ethnic groups.
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