Despite the fact that their disease may be more severe, a new study shows minorities are less likely than white Americans to see a doctor for psoriasis treatment. Researchers from the Perelman School of Medicine at the University of Pennsylvania found that black, Asian, and other non-Hispanic minorities are about 40 percent less likely to see a dermatologist for psoriasis than whites. Additionally, whites averaged about double the number of doctor's appointments for psoriasis overall compared with non-Hispanic minorities. Rates were similar between white and Hispanic individuals. Researchers published their findings this week in the Journal of the American Academy of Dermatology.
Psoriasis is a chronic inflammatory disease that causes skin cells to multiply faster than normal resulting in raised, red patches covered by silvery scales. It occurs most commonly in a symmetrical manner on the scalp, knees, and elbows but can appear anywhere on the body including the face, genitals, nails, and other places. It also has profound effects on health-related quality of life, and in moderate to severe cases, it carries an increased risk of heart attack, stroke, and premature death. The National Psoriasis Foundation estimates psoriasis affects about 7.5 million Americans.
"While psoriasis is less common among minorities, previous research has shown their disease can be more severe. Despite that, this study shows minorities are less likely to see a dermatologist for treatment," said the study's senior author Junko Takeshita, MD, PhD, MSCE, an assistant professor of Dermatology and Epidemiology at Penn.
The study's lead author was Alexander H. Fischer, MD, MPH, who was a medical student at Johns Hopkins University at the time of the research.
The researchers gathered data from the Medical Expenditure Panel Survey, the most complete source of data currently available on healthcare utilization, cost, and insurance coverage in the United States. All of the information is self- or caregiver-reported over a series of interviews, and is designed to be representative of the general population. The team used information from 2001 through 2013 and identified 842 psoriasis individuals representing over 1.6 million Americans.
An average of 50.8 percent of whites saw a dermatologist for their psoriasis, compared to just 38.3 percent for non-Hispanic minorities, which include blacks, Asians, native Hawaiians and Pacific Islanders, and others. Among Hispanics, 46.7 percent saw a dermatologist for their psoriasis.
In addition to the rates for dermatological visits, whites also averaged approximately twice as many visits to a doctor overall. Researchers found whites averaged 2.69 visits per year, compared to 1.87 for Hispanics and 1.30 for non-Hispanic minorities. In total, this amounts to over 3 million fewer visits per year for psoriasis among non-Hispanic racial minorities compared with whites.
"When you combine the results of our study with the knowledge that psoriasis severity and quality of life impact suggest a larger burden of psoriasis among minorities, it brings into focus the racial gaps that exist in psoriasis care," Takeshita said.
The researchers say more research is needed to understand what may be contributing to these disparities, and if the gap in medical care is directly contributing to the increased severity of disease among minorities.
"Ultimately, increasing awareness of these disparities is the first step in trying to provide equitable care and improve outcomes for all individuals with psoriasis," Takeshita said.
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Alexander H. Fischer et al, Health care utilization for psoriasis in the United States differs by race: An analysis of the 2001-2013 Medical Expenditure Panel Surveys, Journal of the American Academy of Dermatology (2017). DOI: 10.1016/j.jaad.2017.07.052