Black and Hispanic Patients With CISDs Have Increased Barriers to Care

Strategies are need to address the barriers to care experienced by minority patients.

Black and Hispanic patients with chronic inflammatory skin diseases (CISDs) disproportionately experience delays in care compared with White patients, according to findings from a study published in the Journal of the American Academy of Dermatology.

Researchers sought to determine the prevalence of barriers to care in patients with CISDs among multiple racial and ethnic groups using cross-sectional survey data from the National Institutes of Health’s All of Us Research Program.

All participants aged 18 years and older with a CISD who enrolled in the program from May 31, 2017 to January 1, 2022, and completed the Health Care Access and Utilization Survey were included. Multivariable logistic regression was used to evaluate the relationship between race and ethnicity and having barriers to care.

The analysis included 16,986 patients (73.7% women) with a median age of 55.6 years (interquartile range, 38.8-67.3 years).

Broader advocacy efforts by dermatologists and other providers are also needed to address structural racism and systemic issues contributing to health care disparities among historically marginalized populations.

Black patients with CISDs were significantly more likely to have a delay in seeking general (adjusted odds ratio [aOR], 2.38; 95% CI, 1.90-2.96), specialty (aOR, 1.55; 95% CI, 1.27-1.87), and follow-up care (aOR, 2.25; 95% CI, 1.83-2.74) and in filling a prescription (aOR, 2.31; 95% CI, 1.99-2.68) because they could not afford it, compared with White patients. Hispanic patients also were significantly more likely to have a delay in seeking general (aOR, 2.24; 95% CI, 1.82-2.75), specialty (aOR, 1.43; 95% CI, 1.20-1.70), and follow-up care (aOR, 2.28; 95% CI, 1.90-2.73), and in filling a prescription (aOR, 1.75; 95% CI, 1.51-2.01) because they could not afford it, compared with White patients.

Black patients with CISDs were significantly more likely vs White patients to delay medical care owing to transportation issues (aOR, 3.27; 95% CI, 2.72-3.92), not being able to take time off work (aOR, 1.23; 95% CI, 1.02-1.49), needing to provide childcare (aOR, 1.67; 95% CI, 1.18-2.31), needing to provide adult care (aOR, 1.73; 95% CI, 1.13-2.56), and living in a rural area too far from a provider (aOR, 1.67; 95% CI, 1.22-2.26). Hispanic patients also were significantly more likely to delay medical care because of transportation issues (aOR, 1.81; 95% CI, 1.50-2.18), not being able to take time off work (aOR, 1.23; 95% CI, 1.05-1.44), needing to provide childcare (aOR, 2.13; 95% CI, 1.65-2.73), needing to provide adult care (aOR, 2.73; 95% CI, 1.96-3.76), and living in a rural area too far from a provider (aOR, 1.47; 95% CI, 1.09-1.95), compared with White patients.

Asian (aOR, 5.85; 95% CI, 4.27-7.90), Black (aOR, 5.32; 95% CI, 4.32-6.51), and Hispanic (aOR, 4.52; 95% CI, 3.69-5.53) patients were significantly more likely vs White patients to have never seen a provider with a similar background.

Many associations between race and ethnicity and barriers to care were substantially attenuated after accounting for insurance, income, and education.

Among several limitations, participants in the All of Us program may not be representative of US adults, and substantial differences occurred between racial and ethnic groups regarding insurance, income, and education. Also, the participants had a heterogenous set of CISDs.

“To help improve access to care and outcomes for patients with CISDs across racial and ethnic groups, future research is needed to identify strategies to (1) increase the affordability of care and prescription medications, (2) reduce structural barriers to care, and (3) increase healthcare workforce diversity and the delivery of culturally sensitive, competent care,” stated the study authors. “In addition, given our analyses suggesting that socioeconomic inequities may underpin racial and ethnic disparities in the barriers to care among patients with CISDs, broader advocacy efforts by dermatologists and other providers are also needed to address structural racism and systemic issues contributing to health care disparities among historically marginalized populations.”

References:

Nock MR, Barbieri JS, Krueger LD, Cohen JM. Racial and ethnic differences in barriers to care among US adults with chronic inflammatory skin diseases: a cross-sectional study of the All of Us Research Program. J Am Acad Dermatol. Published online October 13, 2022. doi:10.1016/j.jaad.2022.09.054