Research Reveals how Psoriasis Treatment Differs Based on Patient Race, Ethnicity

Kevin Wu, MD

A chronic inflammatory condition like psoriasis requires regular management with a dermatologist. However, the quality of the physician-patient relationship is an important determining factor in the patient's outcome.

A couple of investigators sought to understand if there were any differences in the amount of time spent with patients who have psoriasis. They focused specifically on the association between a patient's race and ethnicity and time spent with a dermatologist for psoriasis treatment.

Analyzation

Kevin K. Wu, MD and April W. Armstrong, MD, MPH, from the Department of Dermatology at Keck School of Medicine, University of Southern California, performed a cross-sectional study of data gathered from the National Ambulatory Medical Care Survey from 2010-2016.

The investigators adjusted for age, sex, type of visit (follow-up or new patient), visit complexity based on the number of reasons for visit, insurance status, psoriasis severity on the basis of systemic psoriasis treatment or phototherapy, and complex topical regimen (3 or more topical agents) in their multivariable linear regression analyses.

According to the study, a weighted estimate revealed 4,201,745 patient visits for psoriasis. Race and ethnicity were self-reported by patients. The statistical tests utilized were 2-tailed with a 2-sided P<.05 deeming statistical significance.

Data Review

A significant difference in the average patient age across racial and ethnic demographics was discovered, along with the use of complex topical regimen.

• Asian patients: 37.2 years; 11.8% on complex topical regimen
• Hispanic patients: 44.7 years; not reported
• Black patients: 33.3 years; 1.5% on complex topical regimen
• White patients: 54.8 years; 1.1% on complex topical regimen

The patient group that received the longest mean duration during visits was non-Hispanic Black patients averaging 20.7 minutes. Hispanic or Latino patients showed a similar duration to non-Hispanic White patients with 15.7 and 15.4 minutes, respectively.

The mean duration for Asian patients was 39.9% shorter than that of White patients, with the average time spent with Asian patients being 9.2 minutes. When assessing the Asian patient group alongside all non-Asian patients as a single group, the mean duration of time with Asian patients was 40.6% shorter.

Conjecture

Investigators noted that despite their tendency to present with more severe psoriasis compared with individuals of other races and ethnicities, the results showed that Asian patients receive significantly less time with a dermatologist.

These data aligned with previous studies that found this demographic was less likely to receive counseling from physicians compared with White patients. However, the reason for the presence of these differences is unclear.

Investigators speculated that unconscious bias, cultural differences in communication, or residual confounding could be possible factors, but that further research is necessary to understand the underlying etiology responsible for the variations observed in this study.

Some limitations that were acknowledged included the self-reported visit duration by physicians or their staff, and the missing data on race and ethnicity that were inferred with the sequential regression method. Additionally, among those who didn't report race and ethnicity, separate unknown characteristics could have played a role in visit duration.

Based on these data, investigators concluded that when comparing the racial and ethnic demographics of patients with psoriasis, dermatologists spend significantly less time with Asian patients than any other group.

"Dermatologists need to allow sufficient time to develop strong physician-patient communication regardless of patient background," they wrote.

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