The Role of Social, Economic and Environmental Factors in Food Allergy Disparities

PROJECT SUMMARY AND ABSTRACT Background: Food Allergy (FA) is a potentially life-threatening chronic condition that affects approximately 32 million U.S. children and adults. While an estimated 7.6% of U.S. children have FA, African-American non- Hispanic children have a significantly elevated risk relative to non-Hispanic white children. Among children

enrolled in the Medicaid program, race and ethnicity were associated with FA such that Asian, Black, and Pacific Islander/Native Hawaiian children had a higher odd of FA compared with white children. In addition, racial and income disparities have been observed in the economic burden of FA and in the likelihood of

receiving guideline-based allergy care. Although evidence of disparities is growing, few studies have examined the source of disparities, especially modifiable factors such as features of the local food environment, and none have used large administrative data from privately insured children. Specific Aims and Methods: Theprimary aims of this study are as follows: 1)To measure racial and

ethnic, income, and geographic disparities in FA diagnosis and management among U.S. children, 2) To assess the contribution of social, economic, and environmental factors to disparities, 3) To identify regional hot spots of FA diagnosis and management outcomes among U.S. children with food allergy. This study will

leverage two complementary administrative data to examine disparities: the Medicaid and CHIP T-MSIS Analytic File (TAF) and the Health Care Cost Institute (HCCI) Commercial Claims Research Dataset. The study population in the TAF will include all children enrolled in the Medicaid program in at least 49 states and

the District of Columbia. The HCCI data will include employer-sponsored insurance claims on approximately 11 million U.S. children ages 0-17 per year. County-level characteristics will be drawn from the University of Wisconsin Population Health Institute's County Health Rankings & Roadmaps and the USDA's Food

Environment Atlas. The empirical approach will use the framework of racial and ethnic disparity put forth in the Institute of Medicine's (IOM) 2003 report, Unequal Treatment. Hypotheses and Expected Results: Our associating stores explain primary study hypotheses are based on a conceptual model risky food environments including t hose with high food insecurity and reduced access to grocery

with poorer food allergy management. Specifically, we hypothesize that the food environment will a statistically significant percentage of the differences in FA diagnosis and management. Significance and Effects on Other Research: This will be the first study to systematically examine disparities in FA diagnosis and management among privately and publicly insured children and the first to leverage

existing data to explore the impact of the food environment on disparities. The food environment represents a potentially modifiable target of intervention to ameliorate disparities in guideline-based allergy care and reduce unintentional allergic reactions.