Sociodemographic Factors Linked to Food Allergy Diagnosis Among High-Risk Children With Atopic Dermatitis

To investigate whether sociodemographic factors related to area deprivation index, insurance status, and race and ethnicity among children with atopic dermatitis influenced diagnosis of food allergy (DFA), access to allergists, or food allergy testing.The study included patients with physician-diagnosed atopic dermatitis aged 0 to 18 years who had been seen for at least 1 primary care visit at an urban academic tertiary center in Chicago, IL, between 2009 and February 8, 2022.The study is a retrospective cohort analysis of children with atopic dermatitis. Pediatric patients who had at least 1 primary care visit recorded in the electronic medical record at the study institution were included. Initially extracted data included date of birth, sex, self-identified race and ethnicity, body mass index, current patient address, and insurance payor. For those patients with DFA (International Statistical Classification of Diseases, Tenth Revision code, allergy list entry, and/or problem list entry for allergy to egg, milk, wheat, soy, peanut, tree nut, fish, shellfish, sesame, and other). The presence and mode of food allergy diagnostic testing (percutaneous, blood, oral challenge, and/or unknown [test done in the past/outside facility]) and the presence of allergist visits were assessed. Socioeconomic status and health disadvantage were analyzed using insurance payor status (Medicaid vs private insurance) and the Area Deprivation Index (ADI) at the census block group. The ADI considers theoretical domains of income, education, employment, crime, and housing quality, and a higher ADI indicates a higher level of socioeconomic disadvantage. χ2, analysis of variance, and logistic regression analyses were used to test the significance of observed differences between the groups and evaluate the association of presumed risk factors with the diagnosis of food allergies.The study evaluated 3365 pediatric patients with atopic dermatitis, comprising 41.3% non-Hispanic Black, 33.9% Hispanic, 6.9% Asian, 14.9% non-Hispanic white, and 3.0% “Other” children. Among all patients, a majority had Medicaid/public insurance (61.4%), with most non-Hispanic Black patients and Hispanic patients being covered by Medicaid (76.3% and 62.8%, respectively), compared with white and Asian children (37.5% and 29.1%, respectively). Among those included, 756 (22.5%) were diagnosed with at least 1 of the top 9 food allergens. Among patients with atopic dermatitis and DFA, Hispanic children with were significantly less likely to be evaluated by an allergist than white or Asian children (65.9% vs 82.8% and 80.3%, P = .001 and P = .02). Among patients with atopic dermatitis and DFA, Non-Hispanic Black children were more likely to have no food allergy diagnostic testing than white children (20.9% vs 12.1%, P = .04) and less likely to have diagnostic evaluation via both blood and skin testing compared with white and Asian children (7.1% vs 15.5% and 22.4%, respectively, P < .01 and P < .001, respectively).Black and Hispanic children with physician-diagnosed atopic dermatitis and food allergy were less likely to see an allergist and undergo objective allergy testing in comparison with white and Asian peers, highlighting issues with quality of care and risk of poor outcomes. Additionally, Black and Hispanic patients were more likely to be on Medicaid/public insurance and live in areas with high socioeconomic disadvantage.Discussions aimed at decreasing barriers to quality care for our most sociodemographically disadvantaged populations are important. Although the generalizability of this study may be limited, the study highlights concerns of inadequate diagnosis and management of children with atopic dermatitis and DFA. Specifically, in high-risk patients, racial and ethnic minorities, and those with higher levels of socioeconomic disadvantage, this study found disparities in obtaining objective food allergy testing and evaluation for food allergy by an allergist, thus adding to potential disadvantages and barriers in an already highly burdened pediatric population.