Characteristics of a diverse urban population of primary antibody deficiency patients

Abstract

Primary antibody deficiency (PAD) disorders are most common primary immunodeficiencies, yet much of the research on these disorders is limited to predominantly Caucasian populations at specialized referral centers. We aimed to explore whether there are clinically important differences within a diverse urban population of PAD patients. Retrospective analysis of electronic medical records at Boston Medical Center (BMC) dating back to 2012 was conducted to identify patients with ICD-9/ICD-10 diagnostic codes for agammaglobulinemia, common variable immunodeficiency, hereditary hypogammaglobulinemia, nonfamilial hypogammaglobulinemia, and IgG deficiency. 57 BMC patients were confirmed to have PAD deficiency upon chart review and included in this study with social demographics, clinical histories, and laboratory characteristics recorded. The PAD cohort at BMC is more diverse than that of the United States Immunodeficiency Network (USIDNET), with 15.8% of BMC subjects identifying as Black/African American compared to 2.8% of USIDNET (P < 0.0001) and 12.3% of BMC subjects identifying as Hispanic compared to 3.5% of USIDNET (P = 0.002). IgG replacement therapy was prescribed less commonly in the BMC cohort (37%) compared to USIDNET (87%, P < 0.0001). Bronchiectasis was more common in Black/African American patients (55.6%, P = 0.043) compared to other PAD patients in the BMC cohort. An urban population of PAD patients that is racially and ethnically more diverse than USIDNET had significantly less usage of IgG replacement therapy. Also, bronchiectasis was more common in Black/African American patients. Further work is needed to explore how social disparities may be influencing treatment and outcomes of PAD patients.