Sociodemographic Characteristics of Penicillin-Allergic Children in a Large Rural Health System

BACKGROUND/OBJECTIVES Sociodemographic factors affect prescription practices and antibiotic stewardship initiatives, yet there is limited information as to whether penicillin allergy label (PAL) is related to sociodemographic factors in rural settings. We hypothesize that PAL in children within our rural health system is associated with clinician characteristics and patient sociodemographic factors such as age, sex, race and ethnicity, insurance type, primary care clinician, and Area Deprivation Index (ADI). METHODS This retrospective case-control study was conducted in a tertiary regional rural health system to describe sociodemographic factors associated with pediatric PAL among children aged 0 to 18 years born between April 9, 2006, and April 9, 2024. RESULTS Among 319 325 children, 9168 (2.9%) were identified with PAL. After adjusting for age, race, sex, and state of residence among pediatric patients, children living outside metropolitan areas and higher ADI decile are directly associated with increased odds of a PAL. Children with PAL are more likely to have commercial insurance compared with Medicaid, although this association was reversed after matched analysis. CONCLUSION Pediatric PAL prevalence is remarkably lower in our rural health setting compared with prior published studies. A near linear relationship between ADI and PAL was observed, with higher ADI associated with increased PAL. Future research is needed to understand the association of sociodemographic factors and indices with PAL in pediatric rural health settings.