Diagnostic disparities in inborn errors of immunity: From clinical suspicion to diagnosis
Background: Emerging evidence suggests that inborn errors of immunity (IEI) are underdiagnosed among underserved populations. However, there remains a lack of national studies evaluating diagnostic disparities in IEI. Objective: We examined disparities in the timely IEI diagnosis and related health...
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| Format: | Article |
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Elsevier
2025-05-01
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| Series: | Journal of Allergy and Clinical Immunology: Global |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772829325000086 |
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| author | Karen M. Gilbert, PhD Robert F. LeCates, MA Alison A. Galbraith, MD, MPH Paul J. Maglione, MD, PhD Stephanie Argetsinger, MPH Nicholas L. Rider, DO Jocelyn R. Farmer, MD, PhD Mei-Sing Ong, PhD |
| author_facet | Karen M. Gilbert, PhD Robert F. LeCates, MA Alison A. Galbraith, MD, MPH Paul J. Maglione, MD, PhD Stephanie Argetsinger, MPH Nicholas L. Rider, DO Jocelyn R. Farmer, MD, PhD Mei-Sing Ong, PhD |
| author_sort | Karen M. Gilbert, PhD |
| collection | DOAJ |
| description | Background: Emerging evidence suggests that inborn errors of immunity (IEI) are underdiagnosed among underserved populations. However, there remains a lack of national studies evaluating diagnostic disparities in IEI. Objective: We examined disparities in the timely IEI diagnosis and related health outcomes. Methods: A retrospective analysis was performed of a US national claims database (years 2007 to 2021). Participants included patients diagnosed with an “unspecified immune deficiency” (uID) and presented with IEI-related symptoms, who later received an IEI diagnosis (n = 1429). We quantified the diagnostic interval from clinical suspicion (uID) to IEI diagnosis and examined its association with sociodemographic factors and related health outcomes. Results: The median (interquartile range) diagnostic interval was 369 (126-808) days. Diagnostic interval was 14% longer among patients residing in predominantly non-White neighborhoods, compared with those in predominantly White neighborhoods (P = .04), despite having more severe IEI-related symptoms at uID diagnosis and significantly more health care encounters for pneumonia (incidence rate ratio, 2.24; 95% confidence interval, 1.40-3.70) and sepsis (incidence rate ratio, 2.15; 95% confidence interval, 1.21-3.99) in the year after uID diagnosis. Residence in neighborhoods with greater deprivation was also associated with more severe IEI-related symptoms and greater health care utilization in the year after uID diagnosis. Older age was associated with longer diagnostic interval (P < .001). Longer diagnostic interval was associated with a longer interval to receiving IgR therapy (hazard ratio, 0.64; 95% confidence interval, 0.49-0.83). Conclusion: We observed significant racial and socioeconomic disparities in the timeliness of IEI diagnosis and IEI-related outcomes. Further studies are needed to address the underlying factors contributing to diagnostic inequity. |
| format | Article |
| id | doaj-art-d335a670941f415183ad12c7d39b037f |
| institution | Kabale University |
| issn | 2772-8293 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Allergy and Clinical Immunology: Global |
| spelling | doaj-art-d335a670941f415183ad12c7d39b037f2025-02-05T04:32:53ZengElsevierJournal of Allergy and Clinical Immunology: Global2772-82932025-05-0142100407Diagnostic disparities in inborn errors of immunity: From clinical suspicion to diagnosisKaren M. Gilbert, PhD0Robert F. LeCates, MA1Alison A. Galbraith, MD, MPH2Paul J. Maglione, MD, PhD3Stephanie Argetsinger, MPH4Nicholas L. Rider, DO5Jocelyn R. Farmer, MD, PhD6Mei-Sing Ong, PhD7Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Mass; Corresponding author: Karen Gilbert, PhD, Department of Population Medicine, Harvard Pilgrim Health Care Institute, 401 Park Dr, Suite 401 East, Boston, MA 02215.Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MassPulmonary Center and Section of Pulmonary, Allergy, Sleep and Critical Care, Boston, MassBoston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MassDepartment of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MassDepartment of Health Systems & Implementation Science, Virginia Tech Carilion School of Medicine, Roanoke, VaProgram in Clinical Immunodeficiency, Division of Allergy & Immunology, Beth Israel Lahey Health, Burlington, MassDepartment of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Mass; Harvard Medical School, Boston, MassBackground: Emerging evidence suggests that inborn errors of immunity (IEI) are underdiagnosed among underserved populations. However, there remains a lack of national studies evaluating diagnostic disparities in IEI. Objective: We examined disparities in the timely IEI diagnosis and related health outcomes. Methods: A retrospective analysis was performed of a US national claims database (years 2007 to 2021). Participants included patients diagnosed with an “unspecified immune deficiency” (uID) and presented with IEI-related symptoms, who later received an IEI diagnosis (n = 1429). We quantified the diagnostic interval from clinical suspicion (uID) to IEI diagnosis and examined its association with sociodemographic factors and related health outcomes. Results: The median (interquartile range) diagnostic interval was 369 (126-808) days. Diagnostic interval was 14% longer among patients residing in predominantly non-White neighborhoods, compared with those in predominantly White neighborhoods (P = .04), despite having more severe IEI-related symptoms at uID diagnosis and significantly more health care encounters for pneumonia (incidence rate ratio, 2.24; 95% confidence interval, 1.40-3.70) and sepsis (incidence rate ratio, 2.15; 95% confidence interval, 1.21-3.99) in the year after uID diagnosis. Residence in neighborhoods with greater deprivation was also associated with more severe IEI-related symptoms and greater health care utilization in the year after uID diagnosis. Older age was associated with longer diagnostic interval (P < .001). Longer diagnostic interval was associated with a longer interval to receiving IgR therapy (hazard ratio, 0.64; 95% confidence interval, 0.49-0.83). Conclusion: We observed significant racial and socioeconomic disparities in the timeliness of IEI diagnosis and IEI-related outcomes. Further studies are needed to address the underlying factors contributing to diagnostic inequity.http://www.sciencedirect.com/science/article/pii/S2772829325000086Inborn errors of immunityprimary immune deficiencydiagnostic delayracial disparitiessocioeconomic disparitiesdiagnosis |
| spellingShingle | Karen M. Gilbert, PhD Robert F. LeCates, MA Alison A. Galbraith, MD, MPH Paul J. Maglione, MD, PhD Stephanie Argetsinger, MPH Nicholas L. Rider, DO Jocelyn R. Farmer, MD, PhD Mei-Sing Ong, PhD Diagnostic disparities in inborn errors of immunity: From clinical suspicion to diagnosis Journal of Allergy and Clinical Immunology: Global Inborn errors of immunity primary immune deficiency diagnostic delay racial disparities socioeconomic disparities diagnosis |
| title | Diagnostic disparities in inborn errors of immunity: From clinical suspicion to diagnosis |
| title_full | Diagnostic disparities in inborn errors of immunity: From clinical suspicion to diagnosis |
| title_fullStr | Diagnostic disparities in inborn errors of immunity: From clinical suspicion to diagnosis |
| title_full_unstemmed | Diagnostic disparities in inborn errors of immunity: From clinical suspicion to diagnosis |
| title_short | Diagnostic disparities in inborn errors of immunity: From clinical suspicion to diagnosis |
| title_sort | diagnostic disparities in inborn errors of immunity from clinical suspicion to diagnosis |
| topic | Inborn errors of immunity primary immune deficiency diagnostic delay racial disparities socioeconomic disparities diagnosis |
| url | http://www.sciencedirect.com/science/article/pii/S2772829325000086 |
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