Racial and Ethnic Healthcare Disparities in Atopic Dermatitis

Hypothesis. i) Racial/ethnic differences exist in the severity, disease course and associated comorbidities of AD. ii) Current severity assessment tools are inadequate for minority patients. Objective. i) To analyze the effects of racial/ethnic healthcare disparities on pediatric and adult AD using a prospective longitudinal study of adult and pediatric AD patients at Northwestern University (NU) and ii) Develop improved instruments for assessing the severity of AD in racial/ethnic minorities. Specific Aim #1. Determine whether there are differences in the severity, QOL impairment, comorbidities and disease course of AD in racial and ethnic minorities. Hypothesis: African- and Hispanic-Americans have more severe AD, greater QOL impairment, persistence of childhood disease into adulthood, greater frequency and duration of flares, and poorer response to topical and systemic treatments. Several factors could underlie these hypothesized disparities, including inherent differences of disease phenotype, socioeconomic, behavioral and cultural differences and other psychosocial factors. Distinct profiles of comorbid disorders in racial/ethnic minorities with AD correspond to subgroups of AD based on distinct pathomechanisms. Using mixed qualitative and quantitative methods in a large-scale longitudinal clinical study, I will test my hypothesis. These studies will advance our understanding of AD, including i) identifying high risk groups in the US population based on race and ethnicity; ii) identifying disease subsets with distinct phenotypes, clinical courses and comorbidities, which will help to determine the mechanisms and improve the treatment of AD; and iii) provide crucial preliminary data for the development of R01 grant during the 2nd and 3rd year of the CDA. Specific Aim #2. Develop improved instruments for the assessment of AD severity in racial and ethnic minorities. Hypothesis: Current AD severity assessment instruments, including SCORAD and EASI, do not perform well in racial and ethnic minorities. These instruments do not measure follicular eczema and PIH in patients of African-American/Afro-Caribbean descent, nor do they compensate for the difficulty in appreciating erythema in higher Fitzpatrick skin types (FPST) or the predilection for head and neck dermatitis in Asians9. As a result, severity assessments for these patients are biased toward lower severity. We will develop improved AD severity assessment tools by modifying EASI and SCORAD to include evaluation of PIH, adjustment for erythema in higher FPST and adjusted weighting for head/neck and hand dermatitis. We will assess for content validity, inter- and intra-rater reliability and correlation with patient-reported outcomes (PRO).