Association of Non-Medical Drivers of Health with Completion of Penicillin Allergy Evaluation.

BACKGROUND

Social vulnerability has been shown to influence penicillin allergy delabeling rates; however, the influence of individual non-medical drivers of health (NMDoH) on penicillin allergy delabeling within protocolized frameworks is unclear.

OBJECTIVE

We sought to determine the association between NMDoH and completion of penicillin allergy evaluation in a safety-net hospital system.

METHODS

We performed a retrospective cohort study of patients with penicillin allergy labels referred for inpatient or outpatient evaluation within a protocolized pharmacist-driven program between March 2022 and February 2025. NMDoH were assessed using the Community Vulnerability Compass (CVC), a census block group-level measure of social vulnerability. Associations between CVC measures and penicillin allergy evaluation completion were assessed using adjusted logistic regression analyses, including sensitivity analysis restricted to the highest and lowest CVC quintiles.

RESULTS

Among 1,238 patients referred, 590 (47.7%) completed penicillin allergy evaluation. Inpatients were more likely to complete evaluation than outpatients (61.5% vs 38.5%, p<0.001). There were no significant differences in demographic factors or most CVC indicators between those who completed evaluation and those who did not. In adjusted analyses, no CVC indicators were independently associated with evaluation completion, except unemployment in the sensitivity analysis (aOR 0.17, 95% CI 0.05-0.65). Hispanic ethnicity was associated with higher odds of evaluation completion (aOR 1.96, 95% CI 1.02-3.78).

CONCLUSION

In a safety-net healthcare system with a protocolized pharmacist-driven delabeling program, measures of social vulnerability were not independently associated with penicillin allergy evaluation completion except for unemployment. These findings suggest that structured, non-allergist-led evaluation pathways may mitigate NMDoH barriers to penicillin allergy delabeling.