Racial and Ethnic Disparities in Pediatric Atopic Dermatitis Prevalence and Care are Persistent and Significant: New Scoping Review

A comprehensive scoping review published recently in Pediatric Dermatology, reveals that significant racial, socioeconomic, regional, and gender-based disparities persist in pediatric atopic dermatitis (AD) prevalence and care across the United States, with particularly pronounced effects among Black and Hispanic children and those from lower socioeconomic backgrounds.1

The study is in line with the increasing focus on health disparities research, particularly within the context of the profound inequities revealed during and in the ongoing wake of the COIVD-19 pandemic,2 wrote the research team from the Northwestern University Feinberg School of Medicine, in Chicago, IL.

The researchers, led by Peter Lio, MD, clinical assistant professor, dermatology, pediatrics, reported that compared with non-Hispanic White children, American Indian/Alaska Native, Hispanic, and Asian children had approximately 1.2-, 1.4-, and 2.45-fold higher odds of developing AD, respectively. Across multiple studies, children of color — particularly Black children — experienced an absolute increase in AD prevalence ranging from 2% to 10%, with prevalence increasing by an additional 1% to 4% over time.1

Lio et al found that children of color also faced a 4% to 24% greater association with AD and were 1.5 to 3.8 times more likely to require hospitalization or urgent care for the condition. Black children with AD were found to have 1.24 times higher odds of poor disease control and were 2.5 to 4.1 times more likely to experience early-onset and persistent disease compared with their White peers.

"Children of color, particularly Black and/or Hispanic children, and children with lower socioeconomic status (SES) had increased AD prevalence, worse AD severity and outcomes, reduced access to care, increased comorbidities and hospitalizations, and were less likely to be seen by a medical professional," Lio and colleagues wrote in their analysis of 53 studies published between January 2021 and May 2024.1

Beyond Clinical Outcomes

Beyond clinical outcomes, the researchers found that Black children with AD compared to White peers were nearly 4 times more likely to be experiencing financial hardship related to their condition and had stunning 32% higher odds of food insecurity. Black children also reported greater AD-related sleep disturbance.1

Disparities in access to care for AD were prominent and related to SES, the authors noted, with Black and Hispanic children less likely to receive certain AD treatments, be evaluated by a medical provider, or undergo allergy testing. Rates of delayed and unfilled prescriptions were higher among Black and Hispanic children, according to the results. Children in these racial and ethnic minorities had longer mean wait times for an initial appointment and for an initial diagnosis of AD. Lio et al also reported greater odds of delays in care related to transportation difficulties among Black and Hispanic compared with non-Hispanic White children.1

A finding that augurs poorly for future balance in AD care and access, the research team discovered that Black children were underrepresented in clinical trials by approximately 10%.

Among other socioeconomic factors affecting AD disparities, prevalence of the condition was 6% higher among children with public insurance compared to those with private insurance. Medicaid-insured children waited an average of 17 days longer for their first dermatology appointment after referral than those privately insured. Higher household income, education level, and insurance coverage were each associated with reduced odds — between 12% and 32% — of psychological comorbidities in children with AD.1

The systematic review was performed across MEDLINE (PubMed), Embase (Elsevier), and Cochrane databases for studies of pediatric patients (aged 18 years or younger) that highlighted at least 1 pediatric AD disparity published from January 2021 through May 2024.

Among the review’s limitations, the authors pointed to their inability to perform statistical analysis because of the wide range of topics and study designs. Also, although the goal was to update data on disparities in pediatric AD care in the context of inequities revealed by the COVID-19 pandemic, many of the studies included analyzed patient date collected prior to January 2020.

"The persistence of health disparities among an increasingly diverse pediatric population necessitates further health equity research," the authors conclude. With more than 50% of US children being children of color—a percentage expected to increase—they stress that "policies and efforts to reduce these disparities must focus on promoting equitable housing, education, and healthcare access" to address the complex interplay of socioeconomic and racial factors affecting pediatric AD outcomes.

References
1. Gottlieb S, Madkins K, Lio P. An updated scoping review of disparities in pediatric atopic dermatitis. Ped Dermatol. Published online April 1, 2025. doi: 10.1111/pde.15914.
2. Phan TT, Enlow PT, Lewis AM, et al. Persistent disparities in pediatric health care engagement during the COVID-19 pandemic. Public Health Rep. 2023;138(4):633-644. doi: 10.1177/00333549231163527