Patterns of allergy immunotherapy care among Florida Medicaid-enrolled children with allergic rhinitis

BACKGROUND: Research demonstrates the benefits of allergy immunotherapy (IT) in reducing allergic rhinitis (AR) symptoms and altering the course of allergic disease. However, little is known about patterns of IT care among U.S. children with AR. OBJECTIVES: Identify demographic and clinical characteristics associated with patterns of IT care. METHODS: Florida Medicaid claims data from 1997-2004 were analyzed to identify children (< age 18) diagnosed with AR and examine patterns of IT care by patient demographic and clinical characteristics. RESULTS: Males were 10% more likely to be diagnosed with AR than females (OR=1.101, 95% CI 1.087 - 1.114, p<0.0001); after adjusting for gender variation in AR diagnosis, males were 34% more likely to receive IT than females (95% CI 1.27 - 1.42, p<0.0001). Hispanics were 18% more likely to be diagnosed with AR than Caucasians (OR=1.18, 95% CI 1.16 - 1.12, p<0.0001), 56% more likely to be diagnosed with AR than African-Americans (OR=1.56, 95% CI 1.54 - 1.59, p<0.0001), and 77% more likely than those of other races/ethnicities (OR=1.77, 95% CI 1.72 - 1.81, p<0.0001). After adjusting for variation in AR diagnosis by race/ethnicity, Hispanics were 2.4 times more likely to receive IT than African-American patients (95% CI 2.26 - 2.63, p<0.0001) and 2.2 times more likely to receive IT than Caucasian patients (95% CI 2.02 - 2.30, p<0.0001). Among 520 newly-diagnosed AR patients who received de novo IT and had at least 4 years of claims data following the index AR diagnosis, mean treatment duration was 17 months (SD 17.6). Approximately 39% received IT for less than 6 months; 46.9% completed at least 1 year, 28.6% 2 years, and 16% 3 years. Hispanics received significantly (p=0.003) shorter courses of therapy (mean 429 days, SD 467) than Caucasians (mean 613 days, SD 571), African-Americans (mean 559 days, SD 593), or patients of other races/ethnicities (mean 659 days, SD 624). Hispanics were 1.6 times more likely to discontinue IT within 3 years than Caucasians (Cox proportional hazard =1.63, p = 0.0006). CONCLUSIONS: IT was received by a small percent of AR–diagnosed children, most of whom did not complete the Guideline-recommended minimum 3-year treatment course. Results indicated the following gender and racial/ethnic disparities in IT treatment. First, males with AR were significantly more likely to receive IT than females. Second, although Hispanics were significantly more likely to initiate IT than other racial/ethnic groups, premature discontinuation rates were significantly greater among Hispanics.