Investigators Highlight Disparities Evident in Skin Disease Care, Data Collection

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Posters presented at the American Academy of Dermatology (AAD) 2023 Annual Meeting provided a snapshot of disparities in dermatology care, both in terms of geographic differences in access to care and collection of race/ethnicity data in clinical trials.

One group of investigators used an all-payer claims database to assess patterns of care among adult patients with psoriasis by their state and whether they lived in an urban or rural area.¹ Each patient was assigned a 3-digit zip code prefix (zip3) based on the location of their most frequently visited primary care provider, then their zip3 was categorized as urban or rural using definitions from the Health Resources and Services Administration.

Of 179,688 patients who had at least 1 claim for an advanced psoriasis therapy (apremilast or a biologic) during the 2015-2019 study period, the mean age was 58.5 years. A narrow majority (51%) had commercial insurance, whereas 40% were covered by Medicare. Almost half (49%) had an annual household income of less than $40,000.

In rural areas, 75% of patients received psoriasis-related care outside of their zip3; this proportion was just 2% for patients in urban areas, which the investigators said could be due to insurance network restrictions. Six percent of rural zip3s had 1 or 2 dermatologists available, 3% had 3 or 4, and 7% had 5 or more. These percentages were 24%, 17%, and 41%, respectively, for urban zip3s.

The 5 states with the lowest access, where less than one-third of patients had a psoriasis-treating dermatologist in their zip3, were North Dakota, Hawaii, South Dakota, Minnesota, and Vermont.

The authors noted that all states had a greater proportion of patients receiving biologics vs oral therapies.

“The observed geographic disparities raise the question of whether [psoriasis] treatments that are easy to administer (ie, oral therapies) and/or require little to no monitoring would help to alleviate the burden of limited access to [psoriasis]-treating providers in rural areas,” they wrote.

They called for further research into the differential psoriasis treatment patterns that can spring from geographic disparities in access to specialty care.

Another poster looked at how race/ethnicity data and skin phototype are being reported in phase 2/3 clinical trials for vitiligo therapies worldwide.² After searching the literature and finding 88 such trials published between 2012 and 2022, the investigators performed statistical tests to evaluate reporting rates by trial location.

The percentage of trials reporting race/ethnicity was highest in North America, whereas the percentage of trials reporting skin phototype was highest in Europe. The difference in frequency of reporting race/ethnicity across the continents was statistically significant, but that of reporting skin phototype was not.

Collection of racial/ethnic data from clinical trial participants has been a priority in the United States for years, with the FDA implementing an action plan in 2015 meant to improve transparency and diversity. However, research published more recently has found that Black patients are still underrepresented in trials for newly approved drugs.³

Phototype III (darker white skin) was most commonly represented across all trials, accounting for 35.4% of participants; phototypes I (palest skin) and VI (darkest skin) were less common, at 0.8% and 2.4%, respectively.

Because racial categories are broad and may not account for the nuances within subpopulations, the investigators suggested that trials should report both race/ethnicity and skin phototype to most accurately assess potential associations between these variables and patient outcomes in vitiligo.

References

1. Seigel L, Shoaib S, Maughn K, Wittstock K, Kalirai S, Alexis A. An investigation of geographic disparities in health equity in the treatment of psoriasis. Poster presented at: AAD 2023; March 17-21, 2023; New Orleans, LA. Abstract 43770.

2. Chandan N, Rajkumar J, Puyana C, Haber R. Racial and ethnic disparities in vitiligo clinical trials. Poster presented at: AAD 2023; March 17-21, 2023; New Orleans, LA. Abstract 43936.

3. AJMC Staff. What we’re reading: lead exposure may affect IQ; Florida pediatric vaccine guidance; clinical trial racial disparities. AJMC. March 8, 2022. Accessed March 19, 2023. https://www.ajmc.com/view/what-we-re-reading-lead-exposure-may-affect-iq-florida-pediatric-vaccine-guidance-clinical-trial-racial-disparities