Reframing racial and ethnic disparities in atopic dermatitis in Black and Latinx populations

Abstract

Black people in the United States experience greater atopic dermatitis (AD) prevalence, severity, and persistence when compared with White people. Although very little published literature describes AD in the Latinx population, additional differences in severity, persistence, and age of onset exist in contrast to White people. Thus far, genetic polymorphisms associated with increased risk and/or severity of AD are less common among Black people, so should confer reduced, rather than the observed increased, AD risk among Black people. Little is known regarding genetic risk factors in Latinx people. In contrast, there is consistent evidence that socioeconomic, environmental, and health care factors influence AD prevalence, severity, and/or persistence, and these same risk factors are more common among racial and ethnic minority populations as a result of racism. Researchers too often pursue genetic explanations for racial and ethnic AD disparities when the evidence points to the importance of contextual, rather than genetic, causes of these disparities. Reframing the prevailing view that innate differences among racial and ethnic groups are responsible for these disparities by emphasizing the role of racism and its downstream effects on contextual factors will be a critical first step toward shrinking these disparities.

Keywords: Atopic dermatitis; disparities; eczema; ethnicity; race; racism; social determinants of health.

Figure 1.

Proposed framework for conceptualizing racial and ethnic disparities in atopic dermatitis. Geographical ancestry often correlates with skin pigment, self-identified racial/ethnic identity, and genetic variation that may increase the risk of prevalent or persistent AD in some populations. Racism is arguably the largest shared health risk factor among racial and ethnic minority populations. Health care, socioeconomic status, and environment are linked to features of AD and are therefore conceptualized as mediators of the effects of racism on AD incidence/prevalence, severity, and persistence.