Top Dermatologic Conditions in Patients of Color: An Analysis of Nationally Representative Data

April 2012 | Volume 11 | Issue 4 | Original Article | 466 | Copyright © 2012

Abstract

Background: Some dermatologic disorders are known to be much more common in patients of color, but the leading dermatologic disorders in patients of color have not yet been described on the basis of nationally representative data.
Purpose: To determine the leading dermatologic disorders for each major racial and ethnic group in the United States.
Methods: We queried the National Ambulatory Medical Care Survey (NAMCS) for the leading diagnoses in patient visits to U.S. dermatologists from 1993 to 2009. The leading diagnoses were tabulated for each racial and ethnic group, and the top conditions were compared between groups. In a separate analysis, visits for skin conditions regardless of physician specialty were analyzed for leading diagnoses in each racial and ethnic group.
Results: The top five diagnoses for African-American patients in dermatology clinics were acne, unspecified dermatitis or eczema, seborrheic dermatitis, atopic dermatitis, and dyschromia. For Asian or Pacific Islander patients, the top five were acne, unspecified dermatitis or eczema, benign neoplasm of skin, psoriasis, and seborrheic keratosis. By contrast, in Caucasian patients, the top five were actinic keratosis, acne, benign neoplasm of skin, unspecified dermatitis or eczema, and nonmelanoma skin cancer. In Hispanic patients of any race, the leading diagnoses were acne, unspecified dermatitis or eczema, psoriasis, benign neoplasm of skin, and viral warts. When the leading dermatologic diagnoses across all physician specialties were assessed, the top diagnoses for African-Americans were unspecified dermatitis or eczema, acne, dermatophytosis of scalp and beard, sebaceous cyst, and cellulitis or abscess; for Asians or Pacific Islanders were unspecified dermatitis or eczema, acne, atopic dermatitis, urticaria, and psoriasis; and for Caucasians were acne, unspecified dermatitis or eczema, actinic keratosis, viral warts, and sebaceous cyst. For Hispanics of any race, they were unspecified dermatitis or eczema, acne, sebaceous cyst, viral warts, and cellulitis or abscess. For a sole diagnosis of a dermatologic condition, only 28.5% of African-Americans' visits and 23.9% of Hispanics' visits were to dermatologists, as compared to 36.7% for Asians and Pacific Islanders and 43.2% for Caucasians.
Limitations: The data are based on numbers of ambulatory care visits rather than numbers of patients. Data on race or ethnicity were not collected for some patients.
Conclusions: Several dermatologic disorders are much more commonly seen in patients of color. Acne and unspecified dermatitis or eczema are in the top five for all major U.S. racial and ethnic groups. There may be an opportunity to improve the care of patients of color by ensuring they have equal access to dermatologists.

J Drugs Dermatol. 2012;11(4):466-473.

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INTRODUCTION

Persons of color are a large and growing share of the United States population. 1 Black or African-American individuals comprise 13% of the population or 38.9 mil- lion people according to 2010 Census data, and are expected to grow to by more than 14.6%, or 61 million, by 2050. 2,3 Increased recent immigration from Africa and the Caribbean is signifi- cantly contributing to the growth in this population. 4 Hispanic or Latino individuals, who may be of any race, currently com- prise 16% of the population.5 Since 2000, this population grew by 43%, or by 15.2 million people, accounting for more than half of the growth seen in the total population of the United States over a 10 year period (2000-2010). 1,5 Census estimates project growth of this population to 24.4%, or 102.5 million, by 2050 as immigration and high fertility rates fuel rapid growth. 3 Asian or Pacific Islander individuals are currently 5% of the population, or 15.2 million, and are the fastest growing racial group, expected to rise to 9%, or 41 million, by 2050. 1,3,6 Ad- ditional groups counted among persons of color are American Indians or Alaska Natives (AIAN), and multiracial persons. In total, the number of Americans classified as persons of color 3

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