Published online September 5, 2006
PEDIATRICS Vol. 118 Supplement August 2006, pp. S19-S20 (doi:10.1542/peds.2006-0900GG)
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Differences in Race, Ethnicity, and Socioeconomic Status in Schoolchildren Dispensed Injectable Epinephrine in 3 Massachusetts School Districts

Alan B. Goldsobel, MD

San Jose, CA

ABSTRACT

PURPOSE OF THE STUDY.: To analyze the demographic characteristics of schoolchildren dispensed injectable epinephrine in 3 school districts with widely diverse socioeconomic, racial, and ethnic populations.

STUDY POPULATION.: Students (prekindergarten to grade 12) from 3 school districts in Massachusetts (n = 21 875) were evaluated. Two of the school districts were affluent, suburban towns outside of Boston (5855 students). The third district (16 020 students) was also a Boston suburb but with a very low per-capita income, with 23% of the school-age population living below the poverty line. The 2 suburban districts were 92% and 95% white, respectively, and the third district was 60% nonwhite.

METHODS.: All school districts in Massachusetts are required to report the number of students using daily or as-needed prescription medications to the Department of Public Health. Data were taken from reports filed by school nurses monthly for all students from the 2003–2004 school year for these 3 school districts.

RESULTS.: A total of 181 schoolchildren (0.83%) in the 3 districts were dispensed injectable epinephrine during the school year studied. Diagnoses listed for the prescription of epinephrine included peanut ree nut allergy (65%), stinging-insect allergy (19%), seafood allergy (6%), and egg or dairy allergy (3%). A miscellaneous group (7%) included diagnoses for latex, chocolate, pollen, fruit, cold air, and ibuprofen allergy. Males were more likely to be dispensed epinephrine than females (odds ratio [OR]: 1.44; P < .02). White students were nearly 5 times more likely to have been dispensed epinephrine for peanut and tree nut allergy (OR: 4.5; P < .001) and almost 9 times more likely for stinging-insect allergy (OR: 8.7; P < .001). Seventy-five percent of students dispensed epinephrine for peanut or tree nut allergy were enrolled in prekindergarten through grade 5.

CONCLUSIONS.: Significant racial and socioeconomic differences for prescribing self-injectable epinephrine was seen in 3 school districts in Massachusetts.

REVIEWER COMMENTS.: This study describes the racial and socioeconomic demographics of children prescribed injectable epinephrine but does not address the reasons for the disparity between affluent and nonaffluent or white and nonwhite populations. This study suggests that minority, socioeconomically disadvantaged students are being either underdiagnosed or undertreated for potential anaphylactic reactions that require epinephrine. Other studies have not shown racial differences in the incidence of food allergies, suggesting that other factors are involved in the lower rate of epinephrine dispensed to disadvantaged minority students.

Hannaway PJ, Connelly ME, Cobbett RM, Dobrow PJ. Ann Allergy Asthma Immunol. 2005;95:143–148[ISI][Medline]