Systematic Review Highlights Post-Pandemic Disparities in Pediatric Atopic Dermatitis

A recent update on published data related to pediatric atopic dermatitis disparities highlights the results of several studies around the time of the COVID-19 pandemic, highlighting that children of color and those with specific socioeconomic factors showed increased prevalence and severity in terms of atopic dermatitis.1

This update was authored by a team of investigators led by Simone Gottlieb—an MD candidate from the Department of Dermatology at Northwestern University’s Feinberg School of Medicine—who noted that a significant body of literature on health disparities had increased since the beginning of the COVID-19 pandemic.2

“...[An] update on recently published research on pediatric [atopic dermatitis], which affects up to 20% of children in the United States, is needed,” Gottlieb and colleagues wrote.1 “In this scoping review, we provide an update on recently published pediatric [atopic dermatitis] disparities literature and identify knowledge gaps to guide future research.

Review Process

The investigative team carried out a systematic scoping review using a comprehensive search strategy developed in collaboration with a medical librarian. Searches were done via the Embase (Elsevier), MEDLINE (PubMed) databases as well as the Cochrane Database of Systematic Reviews and Central Register of Controlled Trials (Wiley).

Keywords and database-specific controlled vocabulary that were focused on atopic dermatitis, pediatric populations, and health disparities were used. The team restricted their analysis to studies published from January 2021 onward, as it was a prior scoping review. Searches were done on May 9, 2024, with studies included being required to be published in English and involve either those under 18 or the parents or guardians of pediatric patients within the US.

Additionally, studies that the investigators included also were required to address 1 or more disparities associared with pediatric atopic dermatitis. Two reviewers collaboratively developed and piloted a data extraction spreadsheet for this review, and 53 studies met their inclusion criteria. Among these, 49 studies were shown to have examined disparities based on race or ethnicity, 18 based on socioeconomic status, 11 focused on sex or gender differences, 6 on regional or environmental factors, and 1 study had assessed disparities related to preferred language.

Notable Findings on Disparities

The researchers noted that 17 of 49 studies on racial and ethnic disparities looked into disease prevalence, 12 into comorbidities linked to atopic dermatitis, 11 into access to care, 6 into medical outcomes, and the remainder assessed several other disparity-related issues.

The review highlighted several notable conclusions from various studies, including 1 indicating that compared to non-Hispanic White children, the odds of having atopic dermatitis were elevated among American Indian/Alaskan Native (1.2 times greater), Hispanic (1.4 times greater), and Asian children (2.45 times greater). The investigative team highlighted many studies which had identified additional racial and ethnic disparities, particularly affecting Black and Hispanic children.

These children were shown in several studies to be less likely to be given allergy tests, to receive standard treatments or be assessed by healthcare professionals, and were shown to have higher rates of missed prescriptions. Other findings suggested that such patients experienced longer delays prior to diagnosis and initial appointments, and faced greater rates of delayed care as a result of transportation barriers.

Overall, children of color experienced an absolute prevalence of atopic dermatitis that was 2%–10% were noted by the investigators to be higher than the prevalence observed in White children, along with a 1%–4% greater absolute increase in prevalence over time. Additionally, the team reported that hospitalizations and urgent or ambulatory care visits among such populations were 8%–24% more frequent than those of of White children, with odds ratios ranging from 1.5 - 3.8.

Black children were specifically noted in some of these findings to have 1.24 times the odds (95% CI: 0.99–1.55) of experiencing poorer levels of disease control. They were also 2.5 to 4.12 times more likely in certain of the team's highlighted studies to have early and persistent atopic dermatitis forms compared to their White counterparts.

Disproportionate financial and social burden impacts were also demonstrated among such patients, with studies included in the review pointing to the 1.32 times greater odds (95% CI: 1.09–1.60) among these children of food insecurity, 3.86 times higher odds (95% CI: 1.66–8.98) of harmful financial effects, and increased sleep disturbance (B = 3.89, P < 0.01). These findings were some highlights of the dramatic disparities identified in this review, suggesting the need to address disparities in the field of dermatology.

“The persistence of health disparities among an increasingly diverse pediatric population necessitates further health equity research,” Gottlieb and colleagues concluded. “Analyzing health disparities is the first step to paving the way for future research and interventions that promote health equity for all marginalized patient populations.”1

References

1. Gottlieb, S., Madkins, K. and Lio, P. (2025), An Updated Scoping Review of Disparities in Pediatric Atopic Dermatitis. Pediatric Dermatology. https://doi.org/10.1111/pde.15914.

2. W. S. Brakefield, O. A. Olusanya, B. White, and A. Shaban-Nejad, “Social Determinants and Indicators of COVID-19 Among Marginalized Communities: A Scientific Review and Call to Action for Pandemic Response and Recovery,” Disaster Medicine and Public Health Preparedness 17 (2022): e193.