Analyzing Racial Disparities in Pediatric Atopic Comorbidity Emergency Department Visitation Using Electronic Health...

Area of Science:

• Pediatric Allergy and Immunology
• Health Services Research
• Epidemiology

Background:

• Atopic diseases and their comorbidities are common in children.
• Little is known about racial differences in emergency department (ED) utilization for these conditions.

Purpose of the Study:

• To investigate racial disparities in ED visits among children with allergic comorbidities.
• To examine differences in ED encounter-free survival time and time to recurrence between Black/African American (AA) and White/European American (EA) children.

Main Methods:

• Retrospective study of patients (<21 years) visiting a pediatric ED for atopic dermatitis (AD), food allergy (FA), asthma, allergic rhinitis (AR), and eosinophilic esophagitis (EoE) from 2015-2019.
• Analysis of hazard ratios (HRs) for ED encounters and time to recurrence (TTR).
• Assessment of allergic, demographic, insurance, and place-based factors, including interactions with race.

Main Results:

• 30,894 patients accounted for 83,078 ED encounters.
• Asthma and AR were the most common comorbidities in ED visits for both AA and EA children.
• AA children had higher HRs for encounters following initial AD and asthma visits.
• Insurance type interacted with race, with Medicaid-insured AA children showing higher HRs and EA children showing lower HRs compared to commercially insured peers.
• Allergic comorbidities increased the HR of ED encounters across all allergic diseases.
• AA children had shorter mean TTR for AD, FA, and asthma at 5-year follow-up.

Conclusions:

• Significant racial disparities in ED visitation for childhood atopic diseases were identified.
• These findings highlight the need for targeted interventions to reduce emergency care utilization equitably.
• Understanding these disparities is crucial for designing effective strategies to improve care for atopic children.