How Health Care Disparities in Latin America Impact Numbers of Atopic Dermatitis

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In Latin America, the prevalence of atopic dermatitis (AD) is reportedly as much as 25% in children and 1%-3% in adults, according to numerous papers and studies on the disease. Historically, AD goes into remission in adolescence and adult life, with approximately 10%-30% of patients continuing to experience symptoms of AD in adulthood.

However, in Latin America, these numbers are higher and the health care disparities, including socioeconomic, political, ethnic/racial, and regional factors, may all play a role. After all, those with limited access to health care services, including proper diagnosis and treatment, have increased difficulties coping with AD.

Just how much of a role these factors play is not known. To date, publications about health care disparities in AD in Latin American countries are few and far between. But a new paper may have found answers.

These health disparities in Latin America were the subject of a new study by the Americas Health Foundation (AHF), which brought together a panel of 6 pediatric dermatologists and allergists from Argentina, Brazil, Colombia, Chile, Mexico, and Uruguay to find answers. The physicians all agreed that identifying and addressing health care disparities is of utmost importance to improve the care and quality of life of patients with AD.

The 6 experts spent 3 days together reviewing pertinent literature and discussing their real-world experience to address barriers for health equity in AD and suggest steps to overcome them.

From April 20-22 in 2022, AHF sought proposals for reducing the disparities in access to AD diagnosis and treatment, while also combing through PubMed, MEDLINE, and EMBASE for AD-published allergists and dermatologists in Latin America who had experience with this.

The authors researched phrases such as “treatment,” “diagnosis,” “quality of life,” and “patient journey” in combination with “Latin America,” “atopic dermatitis,” “inequity,” and “health disparities” over a range of 1/1/16 to 2/10/2022, with all articles identified in English, Portuguese, and Spanish.

To get the most out of the experts’ time, AHF prepared specific questions to address health inequities that restricted access to AD diagnosis and treatment in Latin America and allocated one question to each panel member. Then, the panel members submitted a written response to their questions on the basis of the literature they found and their knowledge on the subject from experience.

The panel had difficult discussions about each question through multiple debate rounds until all panelists agreed. The panel unanimously endorsed the recommendations on the basis of the facts obtained, professional opinion, and personal experience, resulting in a paper written after the conference.

This paper published in Dermatology and Therapy¹ looks at the barriers to equal access to care and recommends realistic actions to overcome them. Among the leading causes of health inequity were inadequate disease knowledge, cultural and linguistic barriers, stigmatization, maldistribution of resources, absence of local clinical practice guidelines, arduous patient journey, and limited consultation time.

To combat many of these issues, the 6 experts proposed collaborative networks among Latin American countries; local living guidelines; extension programs from colleges that interact with people who have cultural or language barriers; fostering patient education programs; and utilizing technology—specifically telemedicine—to reach patients to reduce health disparities in Latin America.

When looking at the neuropsychological and emotional impact, the experts noted that the symptoms associated with AD—with pruritus being the most common—profoundly impact a patient's quality of life, as well as their caregivers. This often affects quality of sleep and impairs school and work productivity.

“Anxiety, depression, ADHD, suicidal ideation, and sleep deficit disorder are just a few neuropsychological symptoms patients with AD can experience,” the authors noted.

When discussing the economic impact of AD, it was agreed that this is one of the chief factors of disease severity. “There are considerable disparities in Latin America regarding drug costs and health care access,” the authors wrote. “In Colombia, Mexico, and Peru, the expenses per patient in 2021 for topical treatment, systemic steroids, absenteeism, laboratory tests, and medical appointments ranged from $443 to $6360.50, not including biological treatments or immunosuppressants.”

Then there are environmental factors such as the climate and geography of Latin America, which can see swings in both temperature and humidity, which is believed to influence AD prevalence and severity. Add in dangerous air pollution, factory emissions, and water hardness, and all of those play a role in an increased frequency of AD and other allergic diseases. For instance, children living near factories in Buenos Aires were found to be twice as likely to have AD.

“Some of these factors can be corrected, and we propose different measures to reduce health care disparities in managing AD and thus achieve better disease control with a positive impact on patients and communities in Latin America,” the authors concluded. “The accessibility to new and expensive therapies for AD, and their influence on the health care systems in [Latin America], must be addressed.”

Among the suggested solutions are enhanced education for health care professionals, patients, and the general public, a focus on underprivileged communities, telemedicine and telementoring, translators, multidisciplinary teams, and local living clinical practice guidelines.

Reference

1. Sánchez, Jorge et al. “Health care disparities in atopic dermatitis in Latin America: A Narrative Review.” Dermatol Ther (Heidelb). 2023;13(2):399-416. doi:10.1007/s13555-022-00875-y