Patients with inflammatory skin conditions face racial, ethnic health care barriers
Click Here to Manage Email Alerts
Patients with inflammatory skin conditions from underrepresented racial and ethnic groups, especially Black and Hispanic patients, face more health care barriers than non-Hispanic white patients, according to a cross-sectional study.
Using a survey and multivariable logistic regression, Jeffrey M. Cohen, MD, assistant professor of dermatology and director of the psoriasis treatment program at Yale School of Medicine, and colleagues examined the prevalence of barriers to care among patients with chronic inflammatory skin diseases across racial and ethnic groups.
“Our use of survey data from a large United States database has allowed us to begin to understand the underlying factors contributing to these differences in many individuals with several common inflammatory skin diseases,” Cohen told Healio. “This knowledge is an essential first step in devising strategies to ensure that care is accessible to everyone who needs it.”
The survey was conducted through the NIH All of Us Research Program and included 16,986 participants with chronic inflammatory skin diseases, and researchers focused on 13 survey items to investigate affordability delaying care, structural barriers beyond cost of delaying care and the impact of medicine’s lack of diversity.
Black vs. white patients were significantly more likely to experience a delay in seeking general care (adjusted OR = 2.38; 95% CI, 1.9-2.96), specialty care (aOR = 1.55; 95% CI, 1.27-1.87) and follow-up care (aOR = 2.25; 95% CI, 1.83-2.74). Hispanic vs. white patients were also significantly more likely to experience a delay in seeking general care (aOR = 2.24; 95% CI, 1.82-2.75), specialty care (aOR = 1.43; 95% CI, 1.2-1.7), follow-up care (aOR = 2.28; 1.9-2.73).
Also, both 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 not being able to afford it compared with white patients.
Both Black and Hispanic patients were also significantly more likely to delay care due to varied structural barriers compared with white patients, including because of 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, sex and region, most barriers were experienced by patients on Medicaid vs. private insurance, patients with household incomes of less than vs. more than $100,000 and patients holding less than a college education vs. those with higher education attainment.
Due to the design of the survey, it is unclear whether participants experienced these barriers during treatment for chronic inflammatory skin diseases or other unrelated conditions.
“Understanding that this broad array of barriers exists will hopefully encourage further research in this area and may facilitate innovative strategies to ensure that care is accessible to the entire population,” Cohen said.