Lower socioeconomic status may help explain racial disparities in asthma and atopic dermatitis prevalence: A mediation analysis

Background Racial disparities in atopic disease (atopic dermatitis (AD), asthma, and allergies) prevalence are well documented. Despite strong associations between race and socioeconomic deprivation in the United States (US), and socioeconomic status (SES) and atopic diseases, the extent to which socioeconomic status (SES) explains these disparities is not fully understood. Methods We utilized the National Health Interview Survey (2011-2018), to investigate AD, asthma, and respiratory allergy prevalence in Black and White children and the extent to which measures of SES explain any identified disparities. Results Atopic dermatitis prevalence by race was: White:11.8%, 95% CI [11.4, 12.2] and Black:17.4%, 95% CI [16.6, 18.3]. Asthma prevalence was: White:7.4%, 95% CI [7.0, 7.7] and Black:14.3%, 95% CI [13.5, 15.0]. Respiratory allergy prevalence was: White:11.4%, 95% CI [11.0, 11.9] and Black:10.9%, 95% CI [10.3, 11.6]. The percentage of the disparity between racial groups and disease prevalence explained by a multivariable measure of SES was 25%, 95% CI [15, 36] for Black vs. White children with AD and 47%, 95% CI [40, 54] for Black vs. White children with asthma. Conclusion In a nationally representative US population, Black children had higher prevalence of AD and asthma than White children and similar prevalence of respiratory allergy; a multivariable SES measure explained a proportion of the association between Black vs. White race and AD and a much larger proportion for asthma. Clinical Implication Interventions aimed at improving SES, such as helping families achieve home ownership or increased food assistance, may improve racial disparities in AD and asthma prevalence among Black children.