Journal of the National Medical Association · 2020
Racial and Ethnic Disparities in Access to Emerging and Frontline Therapies in Common Dermatological Conditions: A Cross-Sectional Study.
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Bell Michael A, Whang Katherine A, Thomas Jamael, Aguh Crystal, Kwatra Shawn G
Аннотация
OBJECTIVE: This study investigates possible race- and ethnicity-related disparities in the treatment of acne, atopic dermatitis, and psoriasis of newly approved treatments as well as existing therapies.
METHODS: Aggregate level data was collected from patient medical records between 2013 and 2018. The odds ratio of patients who had been prescribed treatments for acne, atopic dermatitis, and psoriasis per racial and ethnic group were calculated using a 95% confidence interval after applying Bonferroni correction to account for multiple comparisons.
RESULTS: Black patients with acne had statistically significant (p < 0.001) lower odds of receiving isotretinoin 0.26 [0.22-0.30], adapalene 0.72 [0.67-0.78], tazarotene 0.74 [0.64-0.86], and dapsone 0.39 [0.34-0.45] than white patients. The exceptions were tretinoin 1.28 [1.23-1.34] and benzoyl peroxide 3.00 [2.79-3.23] (p < 0.001). Hispanic patients with acne had statistically lower odds of receiving tretinoin 0.86 [0.79-0.95] (p < 0.001) compared to non-Hispanics. Black patients with atopic dermatitis were less likely to receive desonide 0.90 [0.78-0.93], tacrolimus 0.75 [0.68-0.83], pimecrolimus 0.71 [0.60-0.84], crisaborole 0.39 [0.26-0.57], dupilumab 0.42 [0.27-0.65]. The exception was hydrocortisone 2.50 [2.34-2.65] (p < 0.001). There was no statistically significant difference for Hispanics compared to non-Hispanics. Black patients with psoriasis had a lower likelihood of receiving cyclosporine 0.54 [0.35-0.83] and etanercept 0.65 [0.49-0.87].
CONCLUSIONS: This study demonstrates a racial and ethnic disparity in accessing newly approved and standard of care medical therapies for acne, atopic dermatitis, and psoriasis within the past three years.
METHODS: Aggregate level data was collected from patient medical records between 2013 and 2018. The odds ratio of patients who had been prescribed treatments for acne, atopic dermatitis, and psoriasis per racial and ethnic group were calculated using a 95% confidence interval after applying Bonferroni correction to account for multiple comparisons.
RESULTS: Black patients with acne had statistically significant (p < 0.001) lower odds of receiving isotretinoin 0.26 [0.22-0.30], adapalene 0.72 [0.67-0.78], tazarotene 0.74 [0.64-0.86], and dapsone 0.39 [0.34-0.45] than white patients. The exceptions were tretinoin 1.28 [1.23-1.34] and benzoyl peroxide 3.00 [2.79-3.23] (p < 0.001). Hispanic patients with acne had statistically lower odds of receiving tretinoin 0.86 [0.79-0.95] (p < 0.001) compared to non-Hispanics. Black patients with atopic dermatitis were less likely to receive desonide 0.90 [0.78-0.93], tacrolimus 0.75 [0.68-0.83], pimecrolimus 0.71 [0.60-0.84], crisaborole 0.39 [0.26-0.57], dupilumab 0.42 [0.27-0.65]. The exception was hydrocortisone 2.50 [2.34-2.65] (p < 0.001). There was no statistically significant difference for Hispanics compared to non-Hispanics. Black patients with psoriasis had a lower likelihood of receiving cyclosporine 0.54 [0.35-0.83] and etanercept 0.65 [0.49-0.87].
CONCLUSIONS: This study demonstrates a racial and ethnic disparity in accessing newly approved and standard of care medical therapies for acne, atopic dermatitis, and psoriasis within the past three years.