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Atopic dermatitis disproportionately affects diverse patient populations. Furthermore, complex factors may influence the burden of disease and access to treatment amongst different racial and ethnic groups. The aim of this study is to evaluate health disparities and real-world management patterns in distinct populations treated for AD in routine clinical practice. The study included patients with AD (≥age 6) enrolled in TARGET-DERM, an observational, longitudinal study of over 2500 participants across 43 US academic/community centers. Participants were classified in four race/ethnicity categories as reported in enrollment forms and/or patient self-reported: non-Hispanic (NH) White, Black, Asian/Pacific Islander (API) and Hispanic. Patient characteristics analysed included demographics, clinical characteristics, investigator-assessed and patient-reported outcomes, and treatment history. A total of 1928 patients (mean age 34 years; 58% female; 60% enrolled at community-based centers) were included, encompassing 251 NH-Black (13%), 271 NH-API (14%), 288 Hispanic (15%) and 1118 NH-White (58%) participants. Most (71%) had a medical comorbid condition with 30% having ≥3 conditions. Private insurance was highest among NH-APIs (82%) and NH-Whites (70%), Medicaid was highest among Hispanics (46%) and NH-Blacks (27%), and uninsured was highest among NH-Blacks (18%) and NH-Whites (12%). At enrollment, clinical disease severity assessments [vIGA-AD, TBSA and vIGA-ADxTBSA (VxT)] varied by race/ethnicity, also suggesting healthcare disparities. Lowest severity was among NH-Whites (25.9% vIGA-AD clear/almost clear, 26.7% VxT clear/almost clear and median TBSA 5%), followed by Hispanics (21.7%, 18.2% and 7%), NH-Blacks (15.7%, 15.3% and 10%), and NH-APIs (10.7%, 13.8% and 8%). No differences were identified in the distribution of traditional systemic therapies across groups. However, in multivariable analysis (adjusted for age, sex, insurance status, comorbidities, vIGA and treatment status), NH-Blacks and Hispanics were less likely to be treated with advanced systemic therapies than NH-Whites [odds ratio (OR) of 0.67 and 0.70, respectively; P < 0.01]. Similarly, NH-APIs were more likely to have higher vIGA-AD scores than NH-Whites (OR = 1.57; P < 0.01). Non-Hispanic Blacks also had higher vIGA-AD scores than NH-Whites (OR = 1.42; P < 0.05) when controlling for all covariates other than treatment type (P < 0.05), adjustment for which renders the estimated black–white disparity nonsignificant. (OR = 1.32, P = 0.11). Descriptively comparing patient-reported outcome distributions identified no significant differences (P > 0.12). Despite presenting with more severe disease, Blacks and Hispanics have significantly lower odds of using advanced systemic therapy relative to NH-Whites, suggestive of an access disparity leading to disparities in disease control. These disadvantages persist after adjusting for an array of demographic, socioeconomic and medical history characteristics. The results highlight real-world evidence of racial and ethnic disparities among patients with AD. [ABSTRACT FROM AUTHOR]

This paper presents a residual methods approach to identifying social mobility across race/ethnic categories. In traditional demographic accounting models, population growth is limited to changes in natural increase and migration. Other sources of population change are absorbed by the model residual and can be estimated only indirectly. While these residual estimates have been used to illuminate a number of elusive demographic processes, there has been little effort to incorporate shifts in racial identification into formal accounts of population change. In light of growing evidence that a number of Americans view race/ethnic identities as a personal choice, not as a fixed characteristic, mobility across racial categories may play important roles in the growth of race/ethnic subpopulations and changes to the composition of the United States. To examine this potential, we derive a reduced-form population balancing equation that treats fertility and international migration as given and estimates survival from period life table data. After subtracting out national increase and net international migration and adjusting for changes in racial measurement and census coverage, we argue that the remaining error of closure provides a reasonable estimate of net interracial mobility among the native born. Using recent U.S. Census and ACS microdata, we illustrate the impact that identity shifts may have had on the growth of race/ethnic subpopulations in the past quarter century. Findings suggest a small drift from the non-Hispanic white population into race/ethnic minority groups, though the pattern varies by age and between time periods. [ABSTRACT FROM AUTHOR]

Images and interpretations of the past, present, and future of the American racial and ethnic landscape are contradictory. Many accounts focus on the increasing diversity that results from immigration and differential natural increase as well as the proliferation of racial and ethnic categories in census data. Less attention has been paid to the formation and erosion of racial and ethnic identities produced by intermarriage and ethnic blending. The framers and custodians of census racial classifications assume a “geographic origins” definition of race and ethnicity, but the de facto measures in censuses and social surveys rely on folk categories that vary over time and are influenced by administrative practices and sociopolitical movements. We illustrate these issues through an in-depth examination of the racial and ethnic reporting by whites, blacks, Asians, and Hispanics in the 2000 census. The emerging pattern, labeled here as the “Americanization” of racial and ethnic identities, and most evident for whites and blacks, is of simplified racial identities with little acknowledgment of complex ancestries. National origin is the predominant mode of reporting racial and ethnic identities among Asians and Hispanics, especially first-generation immigrants. The future of racial and ethnic identities is unknowable, but continued high levels of immigration, intermarriage, and social mobility are likely to blur contemporary divisions and boundaries. [ABSTRACT FROM AUTHOR]