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Jacobs SR, Ramsey N, Bagnato M, Pitt T, Davis CM. Health disparities in allergic diseases. Curr Opin Allergy Clin Immunol 2024; 24:94-101. [PMID: 38295102 PMCID: PMC10923006 DOI: 10.1097/aci.0000000000000972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
PURPOSE OF REVIEW Healthcare disparities impact prevalence, diagnosis, and management of allergic disease. The purpose of this review is to highlight the most recent evidence of healthcare disparities in allergic conditions to provide healthcare providers with better understanding of the factors contributing to disparities and to provide potential management approaches to address them. This review comes at a time in medicine where it is well documented that disparities exist, but we seek to answer the Why , How and What to do next? RECENT FINDINGS The literature highlights the socioeconomic factors at play including race/ ethnicity, neighborhood, insurance status and income. Management strategies have been implemented with the hopes of mitigating the disparate health outcomes including utilization of school-based health, distribution of educational tools and more inclusive research recruitment. SUMMARY The studies included describe the associations between upstream structural and social factors with downstream outcomes and provide ideas that can be recreated at other institutions of how to address them. Focus on research and strategies to mitigate healthcare disparities and improve diverse research participant pools are necessary to improve patient outcomes in the future.
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Affiliation(s)
- Samantha R. Jacobs
- Department of Pediatrics
- Department of Medicine
- Division of Pediatric Allergy and Immunology
- Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Nicole Ramsey
- Department of Pediatrics
- Division of Pediatric Allergy and Immunology
| | | | - Tracy Pitt
- Department of Pediatrics, Humber Hospital, Toronto, Ontario, Canada
| | - Carla M. Davis
- Department of Pediatrics, Baylor College of Medicine
- Division of Immunology, Allergy and Retrovirology, Baylor College of Medicine and Texas Children's Hospital
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
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Capozza K, Tu M, Schwartz A, Johnson JL, Ladner M. Patients' and Caregivers' Experiences Navigating the Burden of Atopic Dermatitis in Argentina. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:584. [PMID: 38674230 PMCID: PMC11052293 DOI: 10.3390/medicina60040584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: Little is known about patients' and caregivers' experiences with atopic dermatitis (AD) in Argentina, so a survey was administered to learn more. Materials and Methods: A 53-item anonymous survey was administered in Spanish to adult AD patients (n = 334) and caregivers (n = 339) of pediatric AD patients in Argentina (total n = 673). Demographics, healthcare provider information, financial burden, disease severity, disease burden, level of disease-specific education, and experience with shared physician/patient decision making were collected. Linear and logistic regression models were used for statistical comparisons. Results: Survey respondents were overwhelmingly female (90.8%), as was the overall patient population (72.8%). Patients were seen mostly by healthcare specialists (66.8% dermatologists, 13.5% pediatricians, 7.7% allergists, and 7.2% general practitioners). Only 2.8% of respondents reported no symptoms, while 33.3%, 52.4%, and 11.5% reported mild, moderate, and severe AD disease, respectively. Anxiety/depression and pain/discomfort were the most impactful on respondents' quality of life. Caregivers of children with moderate to severe AD and adult patients with severe AD reported a significant financial burden, including using savings or not purchasing food or other essentials to afford medical care. Few people reported receiving disease-specific education or having their own treatment priorities taken into consideration. For adult patients, receiving disease education and being asked about treatment priorities were associated with higher treatment satisfaction and AD control. Discussion: Mental health, pain/discomfort, and financial worries are the most important burdens for adult AD patients and caregivers of children with AD in Argentina. We recommend prioritizing disease-specific education and shared decision making to improve AD care in Argentina.
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Affiliation(s)
- Korey Capozza
- Global Parents for Eczema Research (GPER), Santa Barbara, CA 93101, USA;
| | - Michelle Tu
- Global Parents for Eczema Research (GPER), Santa Barbara, CA 93101, USA;
| | - Alan Schwartz
- Departments of Medical Education and Pediatrics, University of Illinois, Chicago, IL 60607, USA
| | - Jodi L. Johnson
- Departments of Pathology and Dermatology, Northwestern University, Chicago, IL 60611, USA;
| | - Mónica Ladner
- Asociación de Dermatitis Atópica Argentina (ADAR), Buenos Aires C1424BDV, Argentina;
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Maldonado-Puebla M, Akenroye A, Busby J, Cardet JC, Louisias M. Pharmacoequity in Allergy-Immunology: Disparities in Access to Medications for Allergic Diseases and Proposed Solutions in the United States and Globally. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:272-280. [PMID: 37951413 PMCID: PMC10922722 DOI: 10.1016/j.jaip.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 11/14/2023]
Abstract
Pharmacoequity is the principle that individuals should have access to high-quality medications regardless of race and ethnicity, socioeconomic status, or availability of resources. In this review, we summarize access to therapeutics for allergic diseases in the United States and other selected countries. We focus on domains of health care access (health insurance coverage, medication availability, and specialist access) as well as system-level factors and clinician- and patient-level factors such as interpersonal racism and cultural beliefs, and how they can affect timely access to appropriate therapy for allergic diseases. Finally, we propose how pharmacoequity in allergy-immunology can be achieved by highlighting solutions to factors limiting access to medications for allergic diseases, and identify potential future research directions.
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Affiliation(s)
- Martin Maldonado-Puebla
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Ayobami Akenroye
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Boston, Mass; Department of Medicine, Harvard Medical School, Boston, Mass; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Mass
| | - John Busby
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom, (f)Department of Immunology, Boston Children's Hospital, Boston, Mass
| | - Juan Carlos Cardet
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Margee Louisias
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Boston, Mass; Department of Medicine, Harvard Medical School, Boston, Mass.
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Londoño-Garcia A, Arango Salgado A, Orozco-Covarrubias MDLL, Jansen AM, Rico-Restrepo M, Riviti MC, Velásquez-Lopera MM, Castro C. The landscape of vitiligo in Latin America: a call to action. J DERMATOL TREAT 2023; 34:2164171. [PMID: 36594681 DOI: 10.1080/09546634.2022.2164171] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Vitiligo is a chronic pigmentary condition and severely impacts patient quality of life (QoL). It is an underrecognized burden for patients, healthcare systems, and society in Latin America (LA). This paper examines the journey of a vitiligo patient in LA and assesses the disease landscape. Americas Health Foundation (AHF) assembled a panel of six Argentine, Brazilian, Colombian, and Mexican vitiligo experts. On 10-12 May 2022, they met in a virtual meeting. Each panelist wrote a short paper on barriers to vitiligo diagnosis and treatment in LA before the meeting. AHF staff moderated as the panel reviewed and modified each paper over three days. The panel approved the recommendations based on research, professional opinion, and personal experience. The panel agreed that lack of disease awareness and research, social ostracization, and limited therapeutic options hinder patients in their quest for diagnosis and treatment. In addition to the medical and psychological difficulties associated with vitiligo, problems connected to the Latin American healthcare system may negatively impact diagnosis, prognosis, and treatment. Access to timely diagnosis and treatment is crucial for improving outcomes. Governments, medical societies, academics, patient organizations, industry, and the public must unite to eliminate these challenges.
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Affiliation(s)
| | | | | | | | | | - María Cecilia Riviti
- Dermatology Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Margarita María Velásquez-Lopera
- Dermatology Section, Facultad de Medicina, Center for Dermatology Investigation CIDERM, Universidad de Antioquia, Medellin, Colombia
| | - Carla Castro
- Hospital Universitario Austral, Buenos Aires, Argentina
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Soares GB, Orfali RL, Averbach BL, Yosipovitch G, Aoki V. Atopic Dermatitis in Latin America: Considerations on Epidemiology, Clinical and Laboratory Features, Ethnic/Racial Variations, and Therapeutic Management. J Clin Med 2023; 12:jcm12103419. [PMID: 37240525 DOI: 10.3390/jcm12103419] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Latin America (LA) encompasses about 8.5% of the world's population, exhibits ethnic/racial heterogeneity and social inequality. We hereby present a 20-year literature review (2004-2023) on epidemiology, diagnosis, clinical and laboratory features, quality of life and management of atopic dermatitis (AD) in LA. Highest AD prevalence for children aged 6-7 years was reported in Ecuador (22.5%) and Colombia (20.9%), for adolescents in Colombia (24.6%) and for all ages, in Brazil (20.1%). Regions with a predominantly Black population in LA varied significantly, ranging from 4.4% in Northern Brazil to 10.1% in Cuba, indicating genetic variation among African subgroups. Filaggrin loss-of-function mutations showed variants seen in Europeans in 9.3% of Chilean patients and studies in Brazil revealed impaired expression of filaggrin and claudin-1 in the skin but increased expression in conjunctival epithelia of AD patients. The most reported AD features included erythema, pruritus, and dry skin, with marked lichenification. Severe pruritus was reported by 54.4% of patients and a high impact on quality of life was detected in 50% of adults with AD. In Brazilian referral hospitals, 65.6% of patients were classified as having severe AD, and 56% had one or more hospitalizations during their lifetime, indicating a need for better disease control. Diagnosing AD is challenging due to broad clinical features, ethnoracial variations and lack of universal diagnostic criteria. Furthermore, lack of physician training, barriers to medication access, and socioeconomic inequalities hinder effective disease management in LA.
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Affiliation(s)
- Georgia Biazus Soares
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL 33130, USA
| | - Raquel Leao Orfali
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-000, Brazil
| | - Beatriz Lacerda Averbach
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-000, Brazil
| | - Gil Yosipovitch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL 33130, USA
| | - Valeria Aoki
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-000, Brazil
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