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 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, 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 may correspond to subgroups of AD based on distinct pathomechanisms. Specific Aim #2. Standardize EASI and SCORAD use in racial and ethnic minorities. Hypothesis: Current AD severity assessment instruments, including EASI and SCORAD, do not perform well in racial and ethnic minorities. These instruments do not measure follicular and lichenoid eczema in patients of African-American/Afro-Caribbean descent, nor do they compensate for the difficulty in appreciating erythema in skin of color (SOC) or the predilection for head/neck dermatitis in Asians4. As a result, severity assessments for these patients are biased toward lower severity.