Patients pursuing OIT for peanut allergies may face racial, socioeconomic disparities

Key takeaways:

• Black patients with peanut allergies received oral immunotherapy less frequently than white patients.
• Patients with private insurance were more likely to receive oral immunotherapy.

Significant disparities exist between patients with peanut allergies who are currently receiving oral immunotherapy and those who are not, according to a study published in The Journal of Allergy and Clinical Immunology: In Practice.

“This study was prompted after we realized the absence of data on potential health disparities that might exist in food allergy treatments,” Kelly M. O’Shea, MD, a clinical assistant professor in the division of allergy and clinical immunology and department of internal medicine, Mary H. Weiser food allergy center, University of Michigan, told Healio.

“I had noticed a trend in my own clinics, but until we comprehensively evaluated these populations, the true extent of the disparities was unknown,” she said.

Methods

The retrospective cohort study analyzed data from 1,028 peanut-allergic patients aged younger than 18 years who received care in the University of Michigan food allergy clinics between January 1, 2021, and June 30, 2023.

The patients were separated into two groups. The peanut OIT group included 148 patients with a peanut allergy who participated in the Michigan Medicine oral immunotherapy program (MM P-OIT). The control group included 880 peanut-allergic patients who had never participated in the MM P-OIT program.

Researchers noted that the MM P-OIT program is available to any pediatric patients with a peanut allergy. Treatment in the program is not subject to direct patient payments and is fully covered for publicly or Medicaid insured patients.

Data was collected using DataDirect, a self-service tool developed by the University of Michigan Medical School Office of Research. Search terms for ICD-10 codes were applied through DataDirect to identify patients for the study.

Sociodemographic information was also collected for each patient, including sex, age, self-reported race and ethnicity, payer status (insurance type), ZIP code and neighborhood affluence/disadvantage index (NAI, NDI). Higher NAI scores indicate greater affluence, and higher NDI scores represent greater disadvantage.

Insurance type was categorized as private, public, government or none.

Results

Both in the control and treatment groups, patients were primarily white (63.6%, 75%) and non-Hispanic (92.8%, 89.9%) with private insurance (82.2%, 93.2%). Black patients made up 18% of the control group and 4.1% of the treatment group, while white patients made up 75% of the treatment group.

More patients had private insurance in the treatment group than in the control group (93.2% vs 82.2%, P = .0004), while fewer patients in the treatment group were covered by public insurance compared with the control group (6.8% vs 17%, P= .0008).

The NAI was also significantly higher in the treatment group than the control group (0.51 ± 0.18 vs 0.47 ± 0.19, P = .015) while the NDI was significantly lower (0.082 ± 0.062 vs 0.1 ± 0.093, P = .020).

According to logistic regression analysis, Black race was associated with lower odds of participating in OIT when compared with white race, with an odds ratio of 0.19 (95% CI, 0.068-0.54). Patients with private insurance were also more likely to receive OIT with an odds ratio of 0.548 (95% CI, 0.269-1.116).

“The most surprising finding was the degree of these racial and economic disparities,” O’Shea said. “My fear is that these extend beyond our institution.”

She further emphasized that the study results shed light on the need to ensure equitable care for all patients.

“Significantly more work needs to be done to understand the causes contributing to these disparities,” O’Shea said. “Efforts need to be focused on closing these gaps.”