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Multicenter Study
. 2023 May;11(5):1528-1535.e2.
doi: 10.1016/j.jaip.2023.01.034. Epub 2023 Feb 1.

Racial and Ethnic Disparities in Allergen Immunotherapy Prescription for Allergic Rhinitis

Sunjay Modi  1 , Matthew R Norris  2 , Victoria Nguyen  3 , Robert Bower  3 , Timothy J Craig  2 , Taha Al-Shaikhly  2
Affiliations
Multicenter Study

Racial and Ethnic Disparities in Allergen Immunotherapy Prescription for Allergic Rhinitis

Sunjay Modi et al. J Allergy Clin Immunol Pract. 2023 May.

Abstract

Background: Racial and ethnic differences exist in the severity of various atopic diseases including allergic rhinitis (AR). Patients of under-represented races and ethnicities may be subjected to disparate subcutaneous allergen immunotherapy (SCIT) prescription practices.

Objective: To explore the racial and ethnic disparities in the use of SCIT among patients with AR.

Methods: In this retrospective matched cohort study, we used the TriNetX US Collaborative Network, a multicenter electronic health record-based database to identify patients with AR 18 years and older. Patients were grouped according to their racial and ethnic identification. Study groups were matched for baseline demographics, atopic comorbidities, heart diseases and utilization of β-blockers, and angiotensin-converting enzyme inhibitors. The proportion of patients of under-represented racial and ethnic groups started on SCIT was contrasted to the non-Hispanic White cohort.

Results: We identified 1,038,000 patients with AR; the mean age (±standard deviation) at the index was 49.7 (±16.1) years, and 64.6% were female. Ethnicity information was available from 87.3% of patients, and the majority (92.3%) were non-Hispanic. Over a 3-year observation period, fewer Black patients (relative risk [RR], 0.40; 95% confidence interval [CI], 0.33-0.48) and Hispanic patients (RR, 0.80; 95% CI, 0.64-0.99) were started on SCIT compared with non-Hispanic White patients. The proportions of Asian patients who were initiated on SCIT tended to be lower when compared with non-Hispanic White patients (RR, 0.69; 95% CI, 0.47-1.009).

Conclusions: In the United States, differences in SCIT prescription exist between Black and Hispanic patients relative to White patients. Barriers to treatment should be explored and mitigated.

Keywords: AIT; Allergen immunotherapy; Allergic rhinitis; Disparities in health care; Ethnic disparities; Racial disparities; SCIT; Subcutaneous allergen immunotherapy.

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Conflict of interest statement

Conflicts of interests:

T. Al-Shaikhly has patents pending for MicroRNAs as Predictors of Response to Anti-IgE Therapies in Chronic Spontaneous Urticaria as well as for MicroRNAs in Methods of Treatment using Omalizumab and Legelizumab. T. Craig does research for Ionis, Takeda, CSL Behring, Pharvaris, Pfizer, GSK, Regeneron, Kalvista, BioMarin, and Biocryst. He speaks for Takeda, CSL Behring, Grifols and Regeneron. He consults for Takeda, CSL Behring, Biocryst, BioMarin, Incyte, and Spark. He is on the Medical Advisory Board for the US Hereditary Angioedema Association; Director of the Penn State University Angioedema ACARE Resource Center, and Alpha--antitrypsin Resource Center. All other authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Flowchart summarizing the cohort identification process.
Figure 2.
Figure 2.. Black patients with AR are less likely to receive SCIT compared to White patients.
Panel (A) shows the proportions of Black patients with AR started on SCIT over a 3-year observation as compared to a matched cohort of White patients (left) and the Kaplan-Meier curves (right) estimating the 3-year probability of initiating a SCIT for Black (Black line) versus White patients (light grey line). Panels (B) shows the proportions of Asian patients with AR started on SCIT as compared to a matched cohort of White patients (left) and the Kaplan-Meier curves (right) estimating the probability of initiating a SCIT for Asian (Dark grey line) versus White patients (light grey line). Dotted lines represent the 95% CI for the estimated probability. Results shown are after 1:1 propensity score matching.
Figure 3.
Figure 3.. Hispanic and Hispanic-White patients with AR are less likely to receive SCIT compared to White patients.
Panel (A) shows the proportions of Hispanic patients with AR started on SCIT as compared to a matched cohort of White patients (left) and the Kaplan-Meier curves (right) estimating the 3-year probability of initiating SCIT for the Hispanic (Dark blue line) versus White patients (light grey line). Dotted lines represent the 95% CI. Panels (B) shows the proportions of Hispanic White patients with AR started on SCIT as compared to a matched cohort of White patients (left) and the Kaplan-Meier curves (right) estimating the 3-year probability of initiating SCIT for Hispanic White (light blue line) versus White patients (light grey line). Panels (C) shows the proportions of Hispanic non-White patients with AR started on SCIT as compared to a matched cohort of White patients (left) and the Kaplan-Meier curves (right) estimating the 3-year probability of initiating SCIT for Hispanic non-White (light blue line) versus White patients (light grey line). Dotted lines represent the 95% CI for the estimated probability. Results shown are after 1:1 propensity score matching.
See this image and copyright information in PMC

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