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Racial Differences in Food Allergy Phenotype and Health Care Utilization among US Children
Mahboobeh Mahdavinia1, Susan R Fox1, Bridget M Smith2
1Allergy/Immunology Section, Department of Immunology and Microbiology, Rush University Medical Center, Chicago, Ill.
Insights
Food allergy (FA) in children presents different risks and healthcare needs across racial groups. African American and Hispanic children experience more severe outcomes and less consistent specialist care compared to white children.
Area of Science:
- Pediatric Allergy and Immunology
- Health Disparities Research
- Epidemiology of Food Allergies
Background:
- Food allergy (FA) is common in the US, but its characteristics in racial minority populations are not well understood.
- Understanding these differences is crucial for equitable healthcare delivery.
Purpose of the Study:
- To characterize food allergy (FA) disease phenotypes in African American (AA), Hispanic, and white children.
- To identify disparities in healthcare utilization among these groups.
Main Methods:
- Retrospective cohort study of 817 children (aged 0-17) with FA at two urban US tertiary care centers.
- Analysis included logistic regression adjusted for age, gender, and insurance status.
- Comparison of FA phenotypes, co-occurring conditions, and healthcare access across racial/ethnic groups.
Main Results:
- African American children showed higher odds of asthma, eczema, and allergies to wheat, soy, corn, fish, and shellfish compared to white children.
- Hispanic children had higher odds of corn, fish, shellfish allergies, and eczema, with similar asthma rates.
- AA and Hispanic children had shorter follow-up with specialists, higher anaphylaxis rates, and more emergency department visits, with significant differences in Medicaid coverage.
Conclusions:
- Significant differences exist in FA phenotypes and healthcare utilization across racial and ethnic groups in the US.
- African American and Hispanic children face higher risks of adverse outcomes, including more severe allergic reactions and less consistent specialist care.
- Addressing these disparities is essential for improving health equity in pediatric food allergy management.
Background:
Food allergy (FA) is a prevalent condition in the United States, but little is known about its phenotypes in racial minority groups.
Objective:
The objective of this study was to characterize disease phenotypes and disparities in health care utilization among African American (AA), Hispanic, and white children with FA.
Methods:
We conducted a large, 2-center, retrospective cohort study of children aged 0-17 years with FA seen in allergy/immunology clinics at 2 urban tertiary care centers in the United States. We used multiple logistic regression analyses adjusted for age, gender, and insurance.
Results:
The cohort of 817 children was composed of 35% AA, 12% Hispanic, and 53% non-Hispanic white. Compared with non-Hispanic white children, AA children had significantly higher odds of having asthma and eczema (P < .01), and significantly higher odds of allergy to wheat, soy, corn, fish, and shellfish (P < .01). Compared with non-Hispanic white children, Hispanic children had significantly higher odds of allergy to corn, fish, and shellfish (P < .01), and higher odds of eczema (P < .01), but a similar rate of asthma (P = .44). In this cohort, 55%, 18%, and 11% of AA, Hispanic, and white children were covered by Medicaid, respectively (P < .00001). Compared with whites, AA and Hispanic children had a shorter duration of follow-up for FA with an allergy specialist and higher rates of FA-related anaphylaxis and emergency department visits (P < .01).
Conclusions:
FA phenotypes and health care utilization differ among children of different racial and/or ethnic backgrounds in the United States that put AA and Hispanic children at higher risks of adverse outcome than white children. These differences include coexistent atopic conditions, less well recognized food allergens, and higher rates of anaphylaxis.
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