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Structural oppression contributes to the burden of allergic disease

Published: August 19, 2022

The social and political structures into which people are born, live, grow, learn and work play a substantial role in health outcomes. Broadly termed social determinants of health, these structures have a significant influence on health outcomes. Yet, as described by the World Health Organization, these social determinants of health are responsible for perpetuating unfair, and largely avoidable health inequities. There has been a recent shift in public interest toward race and ethnicity as social determinants of health and how these factors uniquely affect certain populations. Despite efforts that begin to address these disparities, many studies on health conditions, including allergic conditions, continue to address affluent populations. Historically oppressed racial and ethnic groups in Canada and the United States represent a large proportion of the population. As such, there is an immediate need to understand how structural oppression contributes to the burden of allergic disease in these populations.

In a recent publication in The Journal of Allergy and Clinical Immunology: In Practice, Jafri and colleagues, performed  a scoping review in which they aimed 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. Informed by guidelines for this type of review, the authors searched three scientific databases, as well as five grey literature sites, for studies on race, ethnicity, and allergy care.

In total, 1198 potentially relevant, unique articles were identified, of which most (1055/1198; 88%) were excluded after reading the full text. This resulted in 143 full-text articles for screening, of which 12 were ultimately included in the review. Most of these included studies (9/12) were from the United States, with fewer (3/12) from Canada. Compared to the general population, the included articles collectively highlighted a greater burden of allergic and atopic diseases, including more emergency department visits, hospitalisations, higher mortality, younger age at diagnosis and more severe disease, amongst structurally oppressed racial and ethnic populations. Also in comparison with the general population, many conditions, including allergies beyond the top 9 food allergens, eosinophilic esophagitis, and asthma, were seemingly more prevalent and more severe, in the populations of interest. Likewise, the increased burden of allergic and atopic disease was substantial amongst the Indigenous Peoples of Canada. As there are few studies on allergy and atopy on Latinx or Hispanic populations, or Native American populations, the same conclusions cannot yet be made. The limited evidence available supports that structurally oppressed racial and ethnic communities face an increased burden of allergic and atopic disease. Further work in this area is necessary to fully glean the extent of structural oppression that contributes to the burden of allergic disease. Moreover, there is a critical need, through engagement with these communities, to identify meaningful ways to address this oppression and improve health outcomes.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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