Asian Patients with Psoriasis Receive Significantly Less Time with Dermatologists

Kevin K. Wu, MD

Asian patients with psoriasis may receive significantly less face-to-face time with dermatologists than patients of other races in the US, according to new findings that support previous research suggesting Asian patients are less likely than White patients to receive direct care counseling.

New data from a pair of dermatologists at the University of Southern California Keck School of Medicine suggest patients with different races or ethnicities receiving care for psoriasis receive disparate mean durations of visit from dermatologists. The findings show Asian patients particularly receive less mean face time with their specialists—despite, ironically, generally presenting with more severe psoriasis than patients of other races or ethnicities.

Kevin K. Wu, MD, and April W. Armstrong, MD, MPH, conducted an analysis on the association between patient race and ethnicity and time spent with a dermatologist for treatment of psoriasis. Dermatologists carry an obligation to provide each patient with the burdensome chronic disease “with adequate time to address their concerns and develop strong communication and trust,” they wrote.

“Ineffective physician-patient communication can mean poor treatment adherence, comprehension, satisfaction, and outcomes for the patient,” they wrote. “It is unclear whether differences exist in the amount of time a dermatologist spends with a patient with psoriasis based on race or ethnicity.”

The pair’s analysis included a cross-sectional study of accrued data from the National Ambulatory Medical Care Survey from 2010 - 2016. They conducted a multivariable linear regression analysis to interpret the possible link between patient race and ethnicity and dermatologist visit duration for psoriasis care. Adjustments for the regression analysis made consideration to patient age, sex, continuation of care, reasons for visit, insurance status, and disease severity based on systemic treatment and topical regimens.

Wu and Armstrong noted that patient race and ethnicity were self-reported.

They identified a weighted estimate of 4 million-plus patient visits for psoriasis in the 7 years of national data. Mean patient age at dermatologist visit varied by race and ethnicity: 37.2 among Asian patients, 44.7 among Hispanic patients, 33.3 years among Black patients, and 54.8 years among White patients (P = .001). A significantly greater rate of Asian patients (11.8%) reported complex topical regimen care versus Black patients (1.5%) and White patients (1.1%), indicating generally more severe disease (P = .03).

Asian patients with psoriasis received 39% shorter duration visit times than White patients (β coefficient, −5.747; 95% CI, −11.026 to −0.469; P = .03):

• Asian patients, 9.2 minutes (95% CI, 4.4 - 14.1)
• Hispanic patients, 15.7 minutes (95% CI, 14.2 - 17.3)
• Black patients, 20.7 minutes (95% CI, 14.5 - 26.9)
• White patients, 15.4 minutes (95% CI, 13.5 - 17.3)

When pooling non-Asian patients as a single group, Asian patients received 40.6% shorter mean duration visits for psoriasis care (β coefficient, −5.908; 95% CI, −11.147 to −0.669; P = .03).

Wu and Armstrong noted the etiology of the findings remain unclear, though factors such as unconscious bias, cultural differences in communication, or residual confounding may be causative.

“Further research is needed to understand the underlying factors responsible for the differences observed in this study,” they wrote.“Dermatologists need to allow sufficient time to develop strong physician-patient communication regardless of patient background.”

The study, “Differences in Face-to-Face Time Spent With a Dermatologist Among Patients With Psoriasis Based on Race and Ethnicity,” was published online in JAMA Dermatology.