Burden of Allergic Disease in Racial and Ethnic Structurally Oppressed Communities Within Canada and the United States: A Scoping Review

Abstract

Background: The social determinants of health have been extensively studied as potential mediating variables in the development and/or progression of many chronic illnesses, including allergic diseases, and may contribute to social inequities as barriers in accessing health care.

Objective: We aimed to perform a scoping literature review to describe the burden of disease and access to health care for treatment of allergic disease within literature specific to structurally oppressed racial and ethnic populations.

Methods: We performed a scoping review, guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines for Scoping Reviews, of 3 scientific databases and 5 relevant gray literature sites. Search strategy including keywords describing race and ethnicity were selected based on the acceptable nomenclature in Canada and the United States. We imposed no restrictions on date or country of publication, study design, or age of participants.

Results: Our literature search yielded 1,198 potentially relevant articles following deduplication. After title and abstract, and subsequently full-text screening, a total of 12 (1.08% of all articles) were included. These 12 included studies pointed toward a higher burden of allergic and atopic disease, including increased presentations to emergency departments, hospitalizations, mortality, younger age of diagnosis, and/or greater severity of disease, among Black or African American individuals, than the general population. Allergies beyond the top 9 food allergens, eosinophilic esophagitis, and asthma appeared to be more prevalent and more severe in this population than in the general population. There appears to be an increased burden of allergic and atopic disease among the Indigenous Peoples of Canada, whereas this was not noted for Latinx or Hispanic populations, in part due to a paucity of studies involving these populations. Owing to a lack of published literature, no conclusions could be drawn regarding allergy and atopy in Native American populations.

Conclusions: Structurally oppressed racial and ethnic communities may face an increased burden of allergic and atopic disease-but that this may be magnified by issues regarding oppression, access, and social environment that warrant further investigation.

Keywords: Allergic disease; Asthma; Atopic dermatitis; Canada; Eosinophilic esophagitis; Food allergy; United States of America.