A NEW study examining over 200,000 patients at a major U.S. medical center has revealed a striking connection between social vulnerability and penicillin allergy labels (PAL), raising questions about how social determinants of health influence medical records and treatment decisions.
Researchers conducted a retrospective case-control study analyzing patients from 2014 to 2023. They found that individuals from socially vulnerable backgrounds, measured using the Community Vulnerability Compass, were significantly less likely to have a documented penicillin allergy. In contrast, patients with lower social vulnerability had a higher prevalence of PAL. The study included 32,952 PAL cases and 171,189 controls, with a diverse patient population: 52.7% Hispanic, 27.1% non-Hispanic Black, 15.5% non-Hispanic White, and 2.2% non-Hispanic Asian.
The findings demonstrated an inverse relationship between social vulnerability and PAL documentation. Patients in the highest social vulnerability quintile had nearly half the odds of having a PAL compared to those in the lowest quintile (OR 0.52; 95% CI, 0.50-0.54). Even after adjusting for social vulnerability, racial disparities persisted. Non-Hispanic White patients were significantly more likely to have a PAL, while Hispanic (adjusted OR 0.38; 95% CI 0.36-0.41), non-Hispanic Black (aOR 0.45; 95% CI 0.42-0.48), and non-Hispanic Asian patients (aOR 0.40; 95% CI 0.34-0.45) had notably lower rates.
These results suggest that racial and ethnic groups navigate the healthcare system differently when it comes to allergy labeling, pointing to potential biases in documentation and patient interactions. Given the known risks associated with PAL, including increased antimicrobial resistance and poorer infectious disease outcomes, this study underscores the need for greater awareness and intervention to ensure equitable allergy documentation and treatment.
Reference: Chow TG et al. The Association of Social Determinants of Health and Penicillin Allergy Labels: a case-control study. Clin Infect Dis. 2025:ciaf153. doi: 10.1093/cid/ciaf153. [Online ahead of print].
Anaya Malik | AMJ
