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Differences in psoriasis outcomes are more likely due to socioeconomic factors than patient race, according to recent findings.
Patients with plaque psoriasis who have skin of color do not appear to face a greater comorbidity burden when compared with patients who are White, new study data indicates. The findings suggest that while patients of color experience poorer outcomes than White patients, comorbidity burden has no association with race.
“Known differences exist regarding treatment outcomes for psoriasis patients with skin of color (SOC), with SOC patients reporting increased risk for hospitalization due to psoriasis and greater negative impact on QOL,” April W. Armstrong, MD, MPH, chief of dermatology at UCLA Health and the David Geffen School of Medicine, Los Angeles, and colleagues wrote in the Journal of Psoriasis and Psoriatic Arthritis. “Several possible explanations exist for this phenomenon.”
Clinicians may underestimate psoriasis severity on dark skin, patients of color are underrepresented in studies of the disease, and socioeconomic factors or access barriers contribute to poorer outcomes, the researchers explained.
Dr. Armstrong and colleagues conducted a cross-sectional, population-based study using records of visits to dermatologists by adult patients with psoriasis. Researchers used the National Ambulatory Medical Care Survey to identify visits that took place between 2002 and 2016, as well as 2018. The CDC carried out the survey, which “provides nationally representative samples of health care visits to physician offices and hospitals across the United States,” the researchers noted. Dr. Armstrong and colleagues identified patients by race, with all races other than White considered “skin of color.”
The study included 39,176,928 weighted outpatient visits. Dr. Armstrong and colleagues used multiple linear regression analysis to compare comorbidity burdens as measured by the Charlson Comorbidity Index (CCI) across racial and ethnic groups. They controlled analyses for sex, age, geographic location, and health insurance status.
Comorbidity Burden by Race
On average, patients were aged 53.5 years, and most weighted visits were by patients who were White Only (34,690,371; 95% CI: 30,872,464-38,508,278).
Dr. Armstrong and colleagues reported the mean CCI was 1.5 for patients described as White Only (standard deviation, ± 0.1).
However, they reported that other racial and ethnic groups did not have statistically significant differences in comorbidities.
For patients identified as Black/African American Only, the average CCI was 1.6 (±0.3; P=0.073 compared with White Only). Asian Only patients had a CCI of 0.7 (±0.2; P=0.435 vs White Only), whereas those who were Native Hawaiian/Pacific Islander had a mean CCI of .9 (±0.6; P=0.403), those who were American Indian/Alaska Native Only had a mean of CCI 2.8 (±0.7; P=0.073), and those whose races were listed as Other had a mean CCI of 0.8 (± 0.3; P=0.195).
Social Differences Between Patient Groups
Dr. Armstrong and colleagues wrote that the results indicated that differences in treatment outcomes among patients with psoriasis were more likely linked to socioeconomic factors rather than the patients’ race.
“The fact that the significant difference in comorbidity burden between Black/African American Only race and White Only race resolves when controlling for insurance type as a proxy for level of care shows that differences in health outcomes in psoriasis patients with [skin of color] are more likely due to factors external to patient race,” the researchers wrote. “These findings align with the previously established consensus that race does not affect health due to biologic differences, but rather because race affects a variety of other social factors that then impact health, such as socioeconomic status.”
