Factors associated with clinical care for food allergy among Medicaid enrolled U.S. children

Abstract

Although racial and ethnic disparities in the use of food allergy (FA)-related services have been documented, little is known about access to services among children in the Medicaid program. The purpose of this study is to measure the utilization of FA-related services and identify factors associated with appropriate care among Medicaid-enrolled U.S. children with FA. Using 2012 Medicaid Analytic eXtract data, we conducted an observational study of children having at least one claim with a FA diagnosis. FA-related services included allergist visits and epinephrine prescription fills. Factors associated with services were assessed using logistic regression. Cox proportional hazard models were used to identify factors associated with time to allergist visit and epinephrine prescription fill in two risk groups. There were 203,480 children ages 0-19 years with a FA diagnosis claim in 2012. Among these children, 18% saw an allergist and 21% visited the ED for FA. Black and Hispanic children with FA were more likely to visit the ED as were those living in less urban counties compared with White children. Hispanic ethnicity and living in a high poverty county were associated with lower hazards of subsequent allergy visits and epinephrine prescription fills. This study finds that few children with FA in the Medicaid program visit allergists or fill epinephrine prescriptions after visits to general pediatricians or family practice clinicians and the ED. Both indicators represent a starting point for measuring quality care for Medicaid enrolled children with FA.