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Drozdowski R, Jain N, Gronbeck C, Feng H. Disparities in Care for Psoriasis. Dermatol Clin 2024; 42:507-512. [PMID: 38796279 DOI: 10.1016/j.det.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2024]
Abstract
Race, ethnicity, language, sex, age, income, insurance status, location, and other socioeconomic and demographic factors influence access to and quality of care for patients with psoriasis, which can potentially lead to inequitable outcomes.
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Affiliation(s)
- Roman Drozdowski
- Department of Dermatology, University of Connecticut Health Center, 21 South Road, 2nd Floor, Farmington, CT 06032, USA
| | - Neelesh Jain
- Department of Dermatology, University of Connecticut Health Center, 21 South Road, 2nd Floor, Farmington, CT 06032, USA
| | - Christian Gronbeck
- Department of Dermatology, University of Connecticut Health Center, 21 South Road, 2nd Floor, Farmington, CT 06032, USA
| | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, 21 South Road, 2nd Floor, Farmington, CT 06032, USA.
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Sherman BW, Henderson R, Kamin L, Phares S. Specialty drug use for autoimmune conditions varies by race and wage among employees with employer-sponsored health insurance. J Manag Care Spec Pharm 2024; 30:497-506. [PMID: 38483271 PMCID: PMC11068654 DOI: 10.18553/jmcp.2024.23163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
BACKGROUND The relationship between race and ethnicity, wage status, and specialty medication (SpRx) use among employees with autoimmune conditions (AICs) is poorly understood. Insight into sociodemographic variations in use of these medications can inform health equity improvement efforts. OBJECTIVE To assess the association of race and ethnicity and wage status on SpRx use and adherence patterns among employees with AICs enrolled in employer-sponsored health insurance. METHODS In this observational, retrospective cohort analysis, data were obtained from the IBM Watson MarketScan database for calendar year 2018. Employees were separated into race and ethnicity subgroups based on employer-provided data. Midyear employee wage data were used to allocate employees into the following annual income quartiles: $47,000 or less, $47,001-$71,000, $71,001-$106,000, and $106,001 or more. The lowest quartile was further divided into 2 groups ($35,000 or less and $35,001-$47,000) to better evaluate subgroup differences. Outcomes included monthly days SpRx-AIC supply, proportion of days covered (PDC), and medication discontinuation rates. Generalized linear regressions were used to assess differences while adjusting for patient and other characteristics. RESULTS From a sample of more than 2,000,000 enrollees, race and ethnicity data were available for 617,117 (29.8%). Of those, 47,839 (7.8%) were identified as having an AIC of interest, with prevalence rates of AICs differing by race within wage categories. Among those with AICs, 5,358 (11.2%) had filled at least 1 SpRx-AIC prescription. Following adjustment, except for the highest wage category, prevalence of SpRx-AIC use was significantly less among Black and Hispanic subpopulations. Black patients had significantly lower SpRx-AIC use rates than White patients (≤$35,000: 4.9 vs 9.4%, >$35,000-$47,000: 5.5 vs 10.6%, >$47,000-$71,000: 8.5 vs 11.1%, and >$71,000-$106,000: 9.1 vs 12.7%; P <0.001 for all). For Hispanic patients, prevalence rates were significantly lower than White patients in 3 different wage categories (≤$35,000: 4.5 vs 9.4%, >$35,000-$47,000: 6.1 vs 10.6%, and >$71,000-$106,000: 8.6 vs 12.7%; P < 0.001). PDC and 90-day discontinuation rates did not differ among race and ethnicity groups within the respective wage bands. CONCLUSIONS Race and ethnicity and wage-related disparities exist in SpRx use, but not PDC or discontinuation rates for treatment of AICs among non-White and low-income populations with employer-sponsored insurance, and may adversely impact clinical outcomes.
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Affiliation(s)
- Bruce W. Sherman
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH
- National Alliance of Healthcare Purchaser Coalitions, Washington, DC
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Salle R, Tubach F, Arlegui H, Curmin R, Viguier M, Beylot-Barry M, Dupuy A, Beneton N, Joly P, De Rycke Y, Jullien D, Mahé E, Paul C, Richard MA, Bachelez H, Zago M, Chosidow O, Sbidian É. Clinical features, therapeutic choice and response by phototype in psoriasis: analysis of the French PsoBioTeq cohort. Clin Exp Dermatol 2023; 48:1238-1246. [PMID: 37409606 DOI: 10.1093/ced/llad233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/22/2023] [Accepted: 07/03/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Little is known about phototype and the response to systemic treatment in psoriasis. OBJECTIVES To assess the characteristics of psoriasis, the therapeutic choice and its efficacy according to phototype. METHODS We included patients from the PsoBioTeq cohort initiating a first biologic. Patients were classified according to their phototype. The evaluation included disease characteristics, choice of the initial biologic and therapeutic response at 12 months based on 90% improvement from baseline in Psoriasis Area and Severity Index (PASI 90) and Dermatology Life Quality Index (DLQI) 0/1. RESULTS Of the 1400 patients included, 423 (30.2%), 904 (64.6%) and 73 (5.2%) were in the phototype I-II, III-IV and V-VI groups, respectively. The V-VI group had a higher initial DLQI, and more frequently initiated ustekinumab. Patients in the V-VI group maintained the initial biologic prescribed as did the other phototype groups, even though the proportion of patients reaching PASI 90 and DLQI 0/1 at 12 months was lower in this group than the other groups. CONCLUSIONS Patient phototype seems associated with quality of life and choice of the initial biologic in psoriasis. The phototype V-VI group less frequently switched treatments than did the other groups when the response was not efficient.
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Affiliation(s)
- Romain Salle
- Department of Dermatology, Hôpital Henri Mondor, Créteil, France
| | - Florence Tubach
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Paris, France
| | - Hugo Arlegui
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Paris, France
| | - Raphaëlle Curmin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Paris, France
| | - Manuelle Viguier
- Department of Dermatology and Venereology, Hôpital Robert Debré, Centre Hospitalier Universitaire (CHU) de Reims, Reims, France
| | - Marie Beylot-Barry
- Department of Dermatology, Hôpital Saint-André CHU de Bordeaux; and Bordeaux Institute of Oncology, INSERM U1312, Team 05, Université de Bordeaux, Bordeaux, France
| | - Alain Dupuy
- Department of Dermatology, CHU de Rennes; Pharmacoepidemiology and Health Services Research, Université de Rennes; and EHESP French School of Public Health, Rennes, France
| | | | - Pascal Joly
- Department of Dermatology, Rouen University Hospital, INSERM U1234, CHU Rouen Normandie, Rouen, France
| | - Yann De Rycke
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Paris, France
| | - Denis Jullien
- Department of Dermatology, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Emmanuel Mahé
- Department of Dermatology, Hôpital Victor Dupouy, Argenteuil, France
| | - Carle Paul
- Department of Dermatology, INSERM Infinity U1291, Paul Sabatier University, Toulouse, France
| | | | - Hervé Bachelez
- Department of Dermatology, Hôpital Saint-Louis, AP-HP; Université Paris Diderot/Université Paris Cité; and INSERM UMR1163, Institut Imagine, Paris, France
| | - Marilyn Zago
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Paris, France
| | - Olivier Chosidow
- Department of Dermatology, Hôpital Henri Mondor, Créteil, France
- Facial Dermatosis Clinic, Hôpital Universitaire Pitié-Salpêtrière, Paris, France; and Université Paris-Est Créteil (UPEC), Créteil, France
| | - Émilie Sbidian
- Department of Dermatology, Hôpital Henri Mondor, Créteil, France
- Clinical Investigation Centre, Hôpital Henri Mondor, Créteil, France
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Masison J, Beltrami EJ, Feng H. Differential patient travel distance and time to psoriasis clinical trial sites. Arch Dermatol Res 2023; 315:2359-2363. [PMID: 37166524 DOI: 10.1007/s00403-023-02633-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 02/20/2023] [Accepted: 05/04/2023] [Indexed: 05/12/2023]
Abstract
Considering the known disparities in racial representation in psoriasis clinical trials, this study sought to characterize travel distance and time to reach a psoriasis clinical trial site as a potential barrier to trial participation for multiple demographic and geographic variables. We determined travel distance and time from every census tract population center in the United States to the nearest psoriasis clinical trial site using ArcGIS and linked travel estimates to demographic characteristics in each census tract based on 2020 American Community Survey. The average distance and time traveled to reach a psoriasis clinical trial site nationally were 45.6 miles and 51.8 min, respectively. Urban residence and Northeast location had significantly lower travel distance and time relative to their geographic counterparts. Travel burden was significantly greater among Native American and Black races, individuals without college education and Veterans Affairs beneficiaries relative to their counterparts. These findings reveal disparate access regarding rurality, race, education and insurance type, which may encourage investigators to increase travel funding for underrepresented groups and diversity recruitment efforts to promote access to psoriasis clinical trials.
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Affiliation(s)
- Joseph Masison
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - Eric J Beltrami
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, 21 South Rd, 2nd Floor, Farmington, CT, 06032, USA.
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Smith B, Engel PV, Javadi SS, Devjani S, Wu JJ. Questions about the BE COMPLETE trial. Lancet 2023; 401:1926-1927. [PMID: 37301578 DOI: 10.1016/s0140-6736(23)00968-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/08/2023] [Indexed: 06/12/2023]
Affiliation(s)
- Brandon Smith
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Priya V Engel
- California University of Science and Medicine, Colton, CA, USA
| | | | | | - Jashin J Wu
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, FL 33101, USA.
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Akuffo-Addo E, Udounwa T, Chan J, Cauchi L. Exploring Biologic Treatment Hesitancy Among Black and Indigenous Populations in Canada: a Review. J Racial Ethn Health Disparities 2023; 10:942-951. [PMID: 35476223 PMCID: PMC9045033 DOI: 10.1007/s40615-022-01282-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 11/30/2022]
Abstract
Biologics are becoming an increasingly important part of patient care across Canada. Recent studies from the USA show that Black patients are less likely than White patients to receive biologic treatment for several medical conditions. The relative lack of race-based data in Canada makes it difficult to replicate such studies in Canada. As a result, there is a paucity of literature that explores the association between biologic usage and race in Canada. Our review aims to explore the factors that might be driving racial treatment disparity in Canada that likely parallels the inequalities found in the USA. We provide a summary of the available literature on the factors that contribute to biologic treatment hesitancy among Black and Indigenous populations in Canada. We highlight several solutions that have been proposed in the literature to address biologic treatment hesitancy. Our review found that biologic treatment decision at the individual level can be very complex as patient's decisions are influenced by social inputs from family and trusted community members, biologic-related factors (negative injection experience, fear of needles, formulation, and unfamiliarity), cultural tenets (beliefs, values, perception of illness), and historical and systemic factors (past research injustices, socioeconomic status, patient-physician relationship, clinical trial representation). Some proposed solutions to address biologic treatment hesitancy among Black and Indigenous populations include increasing the number of Black and Indigenous researchers involved in and leading clinical trials, formally training physicians and healthcare workers to deliver culturally competent care, and eliminating financial barriers to accessing medications. Further research is needed to characterize and address race-based new treatment inequalities and hesitancy in Canada.
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Affiliation(s)
- Edgar Akuffo-Addo
- Undergraduate Medical Education, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. .,Medical Information, Amgen Canada Inc., Mississauga, ON, Canada.
| | - Theodora Udounwa
- Medical Information, Amgen Canada Inc., Mississauga, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Jocelyn Chan
- Medical Information, Amgen Canada Inc., Mississauga, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Laura Cauchi
- Medical Information, Amgen Canada Inc., Mississauga, ON, Canada
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Unmet Need in People with Psoriasis and Skin of Color in Canada and the United States. Dermatol Ther (Heidelb) 2022; 12:2401-2413. [PMID: 36131193 PMCID: PMC9588130 DOI: 10.1007/s13555-022-00811-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/05/2022] [Indexed: 11/24/2022] Open
Abstract
The experience of dermatological conditions such as psoriasis is different for people with skin of color (SoC) than for white individuals. The objective of this literature review was to understand challenges and unmet needs associated with access to care, diagnosis, and treatment of psoriasis among people with SoC in Canada and the United States. The review focused on studies published in the last 5 years. After screening 919 unique records, 26 studies were included. Importantly, lack of culturally competent care was identified as a key unmet need for psoriasis among people with SoC. In addition, cost of care and cultural views of psoriasis may influence decisions to seek care among people with SoC. Baseline patient characteristics in psoriasis studies and the prevalence/incidence of psoriasis vary across racial/ethnic groups, which may reflect differences in the rate and/or timing of diagnosis. The presentation of psoriasis differs across racial/ethnic groups, which may contribute to challenges in proper and timely diagnosis. Compared with white patients with psoriasis, individuals with SoC may be less familiar with and have different rates of treatment with biologic therapies for psoriasis, are more likely to be hospitalized for psoriasis, and their access to physicians may differ. Further, people with SoC are underrepresented in clinical trials of psoriasis therapies. Overall, the results of this literature review suggest that people with psoriasis and SoC face unique challenges in their disease experience. It is essential that clinicians and other stakeholders recognize and address these disparities to ensure equitable care. Skin conditions such as psoriasis are experienced differently by people with skin of color (SoC) compared with white individuals. Although it is known that psoriasis can vary in how it appears between these groups, other factors that affect care for patients with SoC are not well understood. For this review, we focused on challenges associated with accessing healthcare, receiving a diagnosis, and receiving treatment for psoriasis among people with SoC. A search of the academic literature identified several such challenges for people with SoC in Canada and the United States. A major challenge for people with psoriasis and SoC is having access to care that is compatible with their cultural values and practices. The cost of healthcare and cultural views of psoriasis may influence whether individuals with SoC decide to seek care. People with SoC are more likely to be hospitalized for psoriasis, and their access to physicians may differ compared with white individuals. In addition, differences in how psoriasis appears across racial/ethnic groups may hinder diagnosis. Psoriasis treatments that patients with SoC receive may differ from those that white individuals receive, and people with SoC may be less likely to be properly represented in clinical trials evaluating psoriasis therapies. Taken together, the findings of our review indicate that people with psoriasis and SoC face unique challenges in how they receive medical care for their condition. It is essential that clinicians and other stakeholders in the healthcare system recognize these challenges and work to address them.
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Sherman BW, Sils B, Kamin L, Westrich K. Specialty drug and health care utilization vary by wage level in employer-sponsored health plans. J Manag Care Spec Pharm 2022; 28:918-928. [DOI: 10.18553/jmcp.2022.22091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Bruce W Sherman
- School of Medicine, Case Western Reserve University, Cleveland, OH
- National Alliance of Healthcare Purchaser Coalitions, Washington, DC
| | - Brian Sils
- National Pharmaceutical Council, Washington, DC
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Ricardo JW, Lipner SR. Under-representation of racial and ethnic minorities in nail psoriasis randomized clinical trials: A call to action. J Am Acad Dermatol 2022; 86:e267-e268. [DOI: 10.1016/j.jaad.2022.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/12/2022] [Accepted: 01/17/2022] [Indexed: 11/29/2022]
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Shao K, Hooper J, Feng H. Racial/Ethnic Health Disparities in Dermatology in the United States Part 2: Disease-specific Epidemiology, Characteristics, Management, and Outcomes. J Am Acad Dermatol 2022; 87:733-744. [PMID: 35143915 DOI: 10.1016/j.jaad.2021.12.062] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/02/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Abstract
Racial and ethnic disparities in dermatology negatively affect outcomes such as mortality and quality of life. Dermatologists and dermatologic surgeons should be familiar with disease-specific inequities that may influence their practice. The second article in this two-part continuing medical education series highlights gaps in frequency, clinical presentation, management, and outcomes by race and ethnicity. We review cutaneous malignancies including basal cell carcinoma, squamous cell carcinoma, melanoma, Merkel cell carcinoma, dermatofibrosarcoma protuberans, and cutaneous T cell lymphoma, and inflammatory disorders including atopic dermatitis, psoriasis, hidradenitis suppurativa, acne vulgaris, and rosacea.
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Affiliation(s)
- Kimberly Shao
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT
| | - Jette Hooper
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT
| | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT.
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