November 09, 2022
2 minute read
Nock MR, et al. J Am Acad Dermatol. 2022; doi:10.1016/j.jaad.2022.09.054.
The authors do not report any relevant financial information.
According to a cross-sectional study, patients with inflammatory skin conditions from underrepresented racial and ethnic groups, particularly black and Hispanic patients, face more health care barriers than non-Hispanic white patients.
Using a survey and multivariate logistic regression, Jeffrey M. Cohen, MD, assistant professor of dermatology and director of the psoriasis treatment program at the Yale School of Medicine, and colleagues examined the prevalence of barriers to care in patients with chronic inflammatory skin diseases across racial and ethnic groups.
“Our use of survey data from a large US database has allowed us to begin to understand the underlying factors contributing to these differences in many people with several common inflammatory skin diseases,” Cohen told Healio. . “This knowledge is an essential first step in developing strategies to ensure that care is accessible to all who need it.”
The survey was conducted as part of the NIH All of Us research program and included 16,986 participants with chronic inflammatory skin conditions, and researchers focused on 13 survey items to investigate affordability of care. delayers, structural barriers beyond the cost of delayed care, and the impact of lack of diversity in medicine. .
Black patients compared to white patients were significantly more likely to experience delay in seeking general care (adjusted OR = 2.38; 95% CI, 1.9-2.96), specialist care (aOR = 1.55; 95% CI, 1.27-1.87) and follow-up. until care (aOR = 2.25; 95% CI, 1.83-2.74). Hispanic patients compared to white patients were also significantly more likely to experience delay in seeking general care (aOR = 2.24; 95% CI, 1.82-2.75), specialist care (aOR = 1.43; 95% CI, 1.2-1.7), follow-up to care (aOR=2.28; 1.9-2.73).
Additionally, black patients (aOR=2.31; 95% CI, 1.99-2.68) and Hispanic patients (aOR=1.75; 95% CI, 1.51-2.01) experienced significant delays in filling a prescription due to their inability to afford it compared to with white patients.
Black and Hispanic patients were also significantly more likely to delay care due to various structural barriers compared to white patients, including transportation issues (black patients, aOR = 3.27; 95% CI, 2. 72-3.92; Hispanic patients, aOR=1.81; 95% CI, 1.5-2.18), not being able to take time off work (black patients, aOR=1.23; 1.02- 1.49; Hispanic patients, 1.23; 95% CI, 1.05-1.44), childcare needs (black patients, aOR=1.67; 95% CI, 1.18-2 .31; Hispanic patients, aOR=2.13; 95% CI, 1.65-2.73), adult care (black patients, aOR=1.73; 95% CI, 1.13-2, 56; Hispanic patients, 2.73; 95% CI, 1.96-3.76) and living too far from a provider (black patients, aOR=1.67; 95% CI, 1.22-2 .26; Hispanic patients, 1.47; 95% CI, 1.09-1.95).
After adjusting for race, ethnicity, age, gender, and region, most barriers were experienced by patients with Medicaid versus private insurance, patients whose household income was less than $100,000 and patients with college degrees were lower than those with higher education achievement.
Due to the survey design, it is unclear whether participants experienced these barriers while being treated for chronic inflammatory skin diseases or other unrelated conditions.
“Understanding that this wide range of barriers exist will hopefully encourage further research in this area and can facilitate innovative strategies to ensure that care is accessible to the entire population,” Cohen said.