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Ethnic differences in U.S. dermatology service usage identified

A newly published study of the impact of socioeconomic and demographic factors on dermatology service usage in the United States has found that black or Hispanic individuals are only half as likely to visit an dermatologist as a white individual is for the same condition.

Published online ahead of print in JAMA Dermatology (Sept. 26, 2018), the study included nine years of data from 183,054 dermatology patients across the U.S.

“Patients who were male, uninsured, Midwestern, insured by Medicaid/Medicare, or had a lower income or educational status were least likely to receive outpatient dermatologic care,” said the study’s lead author, Raghav Tripathi, MPH, in a press release. Tripathi is a medical student at Case Western Reserve University School of Medicine in Cleveland. The odds of a man seeking treatment for a dermatologic condition were approximately two-thirds that of a woman. Across all patients, service utilization increased proportionately with education level and income.

Per-capita expenditures also varied by ethnicity, with white patients spending approximately three times what black or Hispanic patients spent (US$210 vs. US$63 or US$73, respectively). These ethnic disparities in expenditure persisted after the researchers controlled for controlled for education level, income, insurance status and sex.

“We were surprised by the magnitude of these differences,” Tripathi said. Half of the patients in the new study had a diagnosed dermatologic condition, yet only 36% of diagnosed patients sought care. Most patients diagnosed with a skin condition did not seek care at all during the nine-year study period.

The least likely to seek care were patients diagnosed with chronic skin ulcers, with 90% of patients with chronic skin ulcers not seeing a dermatologist during the study period.

Patients diagnosed with non-melanoma skin cancers were the most likely to seek care, with approximately 75% having at least one outpatient dermatologist visit during the study period. High service utilization in this population could prevent their non-melanoma lesions from turning more serious.

“We hope our findings will encourage hospitals and dermatology clinics to consider their own quality improvement measures, designed to increase access to care among their patients,” said Tripathi. “These could include interventions for minority-specific care, such as having an onsite translator, including a financial counsellor in the appointment, or increasing outreach in rural areas.” The authors note that previous research has shown how dermatologist visits help patients with skin conditions receive earlier and more accurate diagnoses, and improve outcomes.

“Differences in utilization of outpatient dermatologists may be a key predictor for increased mortality and detriment to quality of life in different groups,” Tripathi said. “By understanding the reasons behind these differences through studies like ours, we can begin to develop population-based, targeted interventions.”

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