Servattalab Sarah E, Lee Michelle, Hlobik Madeline, Song Hannah, Huang Jennifer T
Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, MA, USA.
Department of Dermatology, Harvard Medical School, Boston, MA, USA.
Br J Dermatol. 2024 Dec 23;192(1):144-151. doi: 10.1093/bjd/ljae322.
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.
To identify differences in the diagnosis of AD and access to dermatological care by race and ethnicity in infants with AD.
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.
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).
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.
特应性皮炎（AD）是一种炎症性皮肤病，在儿童中很常见，且与医学和社会心理合并症相关。先前的研究表明，AD患儿在医疗保健利用方面存在显著的种族差异；然而，关于皮肤科就诊差异的文献有限。
确定AD婴儿在AD诊断及按种族和族裔获得皮肤科护理方面的差异。
我们对2015年1月1日至2019年12月31日在波士顿儿童医院被诊断为AD的婴儿进行了回顾性病历审查。根据美国少数族裔健康办公室的数据收集标准，种族和族裔被分类为美洲原住民或阿拉斯加原住民；亚洲人；非西班牙裔黑人或非裔美国人；西班牙裔或拉丁裔；夏威夷原住民或其他太平洋岛民；非西班牙裔白人；以及我们称为“其他”的最后一组（这包括所有不属于所列其他组别的个体）。结果包括从皮疹发作到诊断和皮肤科就诊的时间，并使用Kruskal-Wallis检验进行分析。首次皮肤科就诊时的表现严重程度、急诊就诊情况、所开药物和随访情况使用χ²检验进行分析。
与西班牙裔婴儿相比，显著更多的非西班牙裔白人婴儿从儿科医生处获得了AD处方（P = 0.002）。与非西班牙裔白人患者（P = 0.007）相比，非西班牙裔黑人和亚洲婴儿在从儿科医生处获得AD处方后等待看皮肤科医生的时间明显更长（P < 0.001）。与非西班牙裔白人患者（P = 0.003）相比，在生命的第一年，显著更多的非西班牙裔黑人和西班牙裔婴儿因AD到急诊就诊（P < 0.001）。
我们的研究表明，非西班牙裔黑人和西班牙裔AD婴儿在诊断和获得护理方面存在差异，在处方、看皮肤科医生的时间以及急诊就诊情况与非西班牙裔白人婴儿之间存在差异。
