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Analyzing Racial Disparities in Pediatric Atopic Comorbidity Emergency Department Visitation Using Electronic Health
Esteban Correa-Agudelo1, Lili Ding2, Andrew F Beck3
1Division of Asthma Research, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Insights
Racial disparities exist in emergency department (ED) visits for childhood atopic diseases. Black/African American children experienced more frequent ED visits and shorter time to recurrence for conditions like atopic dermatitis and asthma compared to White/European American children.
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.
Background:
Although atopic diseases and associated comorbidities are prevalent in children, little is known about racial differences in emergency department (ED) visitation.
Objective:
We sought to examine racial differences in ED visitation among children with allergic comorbidities.
Methods:
We conducted a retrospective study of patients (<21 years) who visited the ED at a large pediatric hospital for atopic dermatitis (AD), food allergy (FA), asthma, allergic rhinitis (AR), and eosinophilic esophagitis (EoE) from 2015 to 2019. We determined the probability of ED encounter-free survival time using hazard ratios (HRs) and time to recurrence (TTR) of ED encounter for patients identified as Black/African American (AA) and White/European American (EA). We assessed potentially underlying allergic, demographic, and place-based factors and potential interactions between factors.
Results:
A total of 30,894 patients (38% AA and 62% EA) had 83,078 ED encounters (38,378 first ED encounters and 44,700 recurrent ED encounters) during the study period. Asthma and AR showed the highest rate of comorbidity in ED encounters in both AA and EA children. AA children exhibited a higher HR for encounter following index AD and asthma encounters. We found an interaction between the type of insurance and race in ED encounters for AD, FA, AR, and EoE. In AA children, those insured by Medicaid demonstrated a higher HR for any encounter than those with commercial insurance. Conversely, in EA children, those with Medicaid insurance showed a lower HR than their commercially insured peers. Regardless of race, allergic comorbidity increased the HR of ED encounter (1.12-1.62) for all allergic diseases. At 5-year follow-up, mean differences in TTR were shorter in AA children than EA children in AD, FA, and asthma.
Conclusions:
Identification of disease-specific racial disparities in ED visitation related to atopic diseases is a necessary first step toward the design and implementation of interventions capable of equitably reducing emergency care in atopic comorbid children.
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