Lower household income linked to greater food allergy burden among children

Key takeaways:

• Children from lower income households had a 40% greater reaction burden than children from middle- to high-income households.
• The incidence of food allergy reactions decreased for every year of additional age.

WASHINGTON — Children from lower-income homes had more allergic reactions to food than children from higher-income households, according to a poster presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting.

“Our team has previously demonstrated that there are socioeconomic disparities in the food allergy reaction burden in cross-sectional studies,” Neil Thivalapill, MS, medical student and research data analyst associate in the Center for Food Allergy & Asthma Research at Northwestern University Feinberg School of Medicine, told Healio. “However, these types of studies can be limited because they assess patterns at one point in time. Here, we use data from the longitudinal FORWARD study and demonstrated that these socioeconomic disparities persist across the life course of children with food allergies, not just one point in time.”

The researchers sent quarterly surveys to 660 caregivers (55.6% non-Hispanic white; 35.3% non-Hispanic Black; 9.1% Hispanic or Latino) of participants in the FORWARD study to track the incidence of recent food allergy reactions among children. The study collected up to 5 years of person-time per participant and used mixed-effects linear regression models to estimate food allergy reactions by age. Researchers also calculated incidence rate ratios (IRRs) by race and ethnicity, household income, sex, enrollment site and age.

Compared with non-Hispanic white children, the reaction incidence rate was similar in non-Hispanic Black (IRR = 0.9; 95% CI, 0.57-1.4) and Hispanic or Latino children (IRR = 1.03; 95% CI, 0.68-1.55).

However, Thivalapill said his team was surprised by how large the disparity was based on household income. Children with a household income of $100,000 to $200,000 had significantly fewer reactions than children with a household income less than $100,000 (IRR = 0.62; 95% CI, 0.43-0.89). The disparity was also noticeable among children with a household income greater than $200,000 (IRR = 0.6; 95% CI, 0.43-0.85).

“We estimated that for children of households in the lowest income bracket that we studied (less than $100,000), there was almost a 40% higher burden of food allergy reactions, which represents a significant challenge to quality of life,” Thivalapill said.

The researchers also found that as children got older, the incidence of food allergy reactions decreased (IRR per additional year of age = 0.36; 95% CI, 0.35-0.37).

Thivalapill said this study should encourage clinicians to connect patients with lower socioeconomic status to educational and social resources to help them with food allergy management.

“We are eager to continue following the children and families in the FORWARD cohort to determine how long these disparities persist and whether they affect other health outcomes such as other atopic diseases that may only manifest after substantial follow-up,” Thivalapill told Healio. “We are also looking forward to further exploration of socioeconomic disparities in food allergy reaction burden related to additional racial and ethnic groups previously understudied. In particular, we have started recruiting Asian participants into our cohort study in addition to our Black, Hispanic and/or Latino, and white participants.”