Published June 13, 2023, in The Journal of Allergy and Clinical Immunology, this study aims to shed light on the disparities in healthcare outcomes for children with EoE related to their race, socioeconomic status, and area of residence.

Key Findings

The retrospective cohort study analysed data from 2,117 children diagnosed with EoE treated at Children’s Hospital Colorado between 2009 and 2020. The research reveals:

• Children from disadvantaged neighbourhoods had fewer radiographic evaluations and experienced oesophageal dilations at younger ages.
• Black children were generally diagnosed younger than their white counterparts (8.3 years vs 10 years).
• Children residing in rural areas received less feeding therapy and were younger during their visits than those from urban areas.

Discussion

The study finds significant disparities in the presentation and care of EoE in children attributed to their racial background, socioeconomic status, and urbanisation. 

These disparities point towards systemic inequities affecting historically marginalised communities.

In particular, Black children and those from rural or disadvantaged areas appear to have more significant disease severity based on earlier dilation and age of seeing dietitians/feeding therapists. 

These findings echo broader healthcare disparities that intersect with social determinants of health, including race, poverty, and access to healthcare services.

The study hypothesises that these disparities are not due to genetic differences but are more likely due to structural factors and health inequities that have long been interwoven with race, poverty, and urbanisation.

Recommendations

The authors suggest that policies promoting equity in healthcare could help address these disparities. Recommendations include:

• Improved access to specialists like paediatric gastroenterologists, allergists, dietitians, and feeding therapists.
• Policy changes to improve coverage of specialised EoE care, particularly in rural areas.

Limitations

The study has limitations, including its use of ICD-9 and ICD-10 codes to identify children with EoE and that the data are limited to a single healthcare system in Colorado. The data on race and ethnicity was extracted from electronic medical records rather than from patient self-reporting, which might affect the accuracy of this information.

This study serves as a starting point for further work in this area.

Concluding Remarks

The study represents an essential step towards understanding the effects of social determinants on health outcomes in children with EoE. It calls for systemic changes to ensure care parity and improve health outcomes for these vulnerable patient groups.

"In this study of 2,117 children with EoE, children with greater neighborhood disadvantage were found to have less evaluation of their disease and children from rural areas were seen less by feeding therapists. These results suggest that the presentation and care for children with eosinophilic esophagitis may depend on race, urbanization, and socioeconomic status. Policies that promote equity will be critical to improve these disparities. "

- Glenn T. Furuta MD

What This Means For The Patient Community

In alignment with these findings, EOS Network is deeply committed to enhancing healthcare for all groups of patients and their families dealing with eosinophilic diseases.

As an active partner of CEGIR, we are closely involved in discussions concerning research and care. See the latest CEGIR research on enhancing diversity, equity, inclusion, and accessibility in eosinophilic gastrointestinal diseases. 

The core of our Network is a strong belief that sharing knowledge and experience and making quality care accessible to everyone benefits all communities.

With this study shining light on the existing disparities, we continue to advocate for urgent policy changes to bridge these gaps and provide better care for everyone affected by EoE.

Read the publication