Epidemiology of Skin Diseases in a Diverse Patient Population
October 2018 | Volume 17 | Issue 10 | Original Article | 1032 | Copyright © 2018
Jewell V. Gaulding MD,a Daniel Gutierrez MD,b Bhavnit K. Bhatia MD,a Xiaoxia Han PhD,c Richard Krajenta BS,c Christine Neslund-Dudas PhD,c Henry W. Lim MD,a Ellen N. Pritchett MD MPHa
aHenry Ford Hospital, Detroit, MI bNew York University, New York, NY cDepartment of Public Health Sciences, Henry Ford Health Systems, Detroit, MI
BACKGROUND: Epidemiologic studies of patients who present to dermatology clinics are necessary to identify the needs of patients. OBJECTIVE: To quantify and compare diagnoses according to race, ethnicity, and socioeconomic status (SES) at 6 general dermatology clinics from January 2013 to December 2016. METHODS: A retrospective cohort of new patients was established using an electronic medical record database. Primary diagnoses and diagnostic codes were recorded. Geocoding was utilized to obtain SES. RESULTS: There were 65969 new patient visits. Racial and ethnic demographics were obtained with the overall top 3 conditions being eczema or dermatitis, benign skin neoplasm, and adnexal disease. In blacks, however, follicular disorders were the third most common condition seen. The most frequently encountered diagnoses at the clinics with the highest and lowest SES were benign skin neoplasm and eczema or dermatitis, respectively. LIMITATIONS: Only primary diagnoses were included in analysis. Determining one’s race is increasingly difficult. CONCLUSION: Follicular disorders occurred with an increased frequency in blacks. When examining SES, eczema or dermatitis was the most frequently encountered primary diagnosis at the clinic with the lowest SES, with benign skin neoplasm seen with the highest frequency at the clinic with the highest SES. J Drugs Dermatol. 2018;17(10):1032-1036.
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Studies regarding epidemiology are a vital component in recognizing areas of interest, allocating resources, and finding areas of further research. As our society becomes more diverse, epidemiological studies accurately representing this increasing diversity are paramount. To date, only a few studies have investigated the burden of cutaneous disease in skin of color patients.1-6Janumpally et al revealed that blacks and Asian or Pacific Islanders were more likely to make office visits for atopic dermatitis compared to whites utilizing the data from the US National Ambulatory Medical Care Survey.1 Utilizing the same database, acne and unspecified dermatitis or eczema were common diagnoses across groups; however, seborrheic dermatitis, atopic dermatitis, and dyschromia were more common in African Americans. Furthermore, patients who were Asian or Pacific Islander more commonly presented for seborrheic keratosis while patients who were Hispanic or Latino more frequently presented for viral warts. Caucasians presented for actinic keratosis and non-melanoma skin cancer. Patients who were Asian or Pacific Islanders and Latino presented for psoriasis and both Caucasians and Asian or Pacific Islanders frequently presented for benign neoplasm of skin.2 In a 2007 study in New York by Alexis et al comparing black and white patients, alopecia was seen as a top 5 diagnosis in black patients, while psoriasis was seen more frequently in Caucasian patients.3The primary aim of this study is to compare the most common diagnoses according to the race and ethnicity of new patients seen at the Henry Ford Health System (HFHS) general dermatology outpatient clinic from 2013 to 2016. Our secondary aim was to examine socioeconomic status (SES). To our knowledge, this is the first epidemiologic study of its kind with a focus on primary diagnoses based on race and SES in a general dermatology clinic.
PATIENTS AND METHODS
The HFHS Institutional Review Board reviewed and approved this study (protocol No. 11148). A retrospective analysis was performed utilizing the electronic medical record of the HFHS in Detroit, Michigan. Data was attained from 6 HFHS clinics located within the Detroit metropolitan area, consisting of nearly 5 million people and 9 counties. The racial and ethnic composition of this area is 70% white, 23% African American, 0.3%