Sociodemographic background may affect ‘not relevant’ responses on DLQI
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Gender, income and marital status may predict the likelihood of reporting “not relevant” to certain questions on the Dermatology Life Quality Index among patients with psoriasis, suggesting a possible underestimation of disease burden, according to recent findings.
John S. Barbieri, MD, MBA, research fellow in the department of dermatology at the University of Pennsylvania Perelman School of Medicine, and Junko Takeshita, MD, PhD, MSCE, assistant professor of dermatology and epidemiology in the department of dermatology and department of biostatistics, epidemiology and informatics at the University of Pennsylvania Perelman School of Medicine, explained the impetus for the study. “In this socioeconomically disadvantaged population with a high unemployment rate, many people who were unemployed, retired or disabled were answering ‘not relevant’ to the question that asks about how much a person’s skin condition affects their work,” Takeshita told Healio. “In this particular instance, it did not make sense to me that someone who is not working would necessarily be identified as having the same quality-of-life impact from their skin condition as someone who answered that their skin condition does not affect or prevent them from working.”
The researchers aimed to assess potential associations between sociodemographic characteristics and the frequency of “not relevant” responses, and also between the frequency of these responses as they associate with treatment satisfaction.
The study included data from 1,733 patients accrued from the Dermatology Clinical Effectiveness Research Network between February 2010 and June 2011. The cohort was 50.7% female and 84.8% non-Hispanic white.
The most frequently reported “not relevant” responses were observed in sport (12.9%), along with sexual difficulties (12.3%), and work or study (7.3%).
Multivariate analysis results showed that men (OR = 0.63; 95% CI, 0.48-0.82) and individuals with an income of more than $100,000 (OR = 0.45; 95% CI, 0.26-0.79) were less likely to report not relevant responses.
Conversely, patients who were more likely to report these responses were single (OR = 1.85; 95% CI, 1.31-2.61), were widowed or divorced (OR = 2.60; 95% CI, 1.80-3.74), and were unemployed or had disabled employment status (OR = 1.98; 95% CI, 1.35-2.89).
“Our findings suggest that there are, in fact, certain sociodemographic characteristics, such as gender, income, marital status, employment status, that are associated with a person’s likelihood of answering ‘not relevant’ to various questions in the DLQI among patients with psoriasis in the U.S.,” Takeshita said. “To me, this means that we should be careful in using and interpreting the results from the DLQI among sociodemographically diverse populations as we may be underestimating the burden of skin disease among specific populations.”
Other findings showed that having a DLQI score that would be reclassified from 10 or less to 10 or greater after modification would yield a lower overall global satisfaction score on the Treatment Satisfaction Questionnaire for Medication (coefficient, –9.8; 95% CI, –16.3 to –3.4).
“We also found an association between not relevant responses and decreased treatment satisfaction, which could be related to potential undertreatment among those who respond not relevant to one or more items on the DLQI,” Barbieri said. – by Rob Volansky
Disclosures: Barbieri reports receiving partial salary support through a Fellowship in Dermatology Patient-Oriented Research grant from Pfizer to the Trustees of the University of Pennsylvania. Takeshita reports receiving a research grant from Pfizer to the Trustees of the University of Pennsylvania for work that is unrelated to this study and receiving payment for continuing medical education work related to psoriasis that was supported indirectly by Eli Lilly and Company and Novartis. Please see the study for all other authors’ relevant financial disclosures.