Care Survey (NAMCS). The NAMCS collects data based on outpatient visits to nonfederally employed office-based physicians involved directly in patient care. Data is collected from the physician, instead of the patient in order to provide more analytic information, which is expanded from other surveys. Each physician is assigned randomly to a 1-week reporting period, during which data from a systematic random sample of visits are recorded. Data recorded by the physician are patient symptoms, diagnoses, and medications prescribed, as well as demographics of patients, procedures, and current or future treatment plan.
We analyzed data from the NAMCS during an 18-year period of data collected from 1993 to 2010. Data analysis was performed via SAS (SAS Institute, Cary, NC). Other demographic analyses included gender, age groups, physician specialties, and patient payment type. Medications prescribed to patients with dyschromia (ICD-9 codes 709.00 or 709.09) were analyzed and compared among the different races. Combination therapy was defined as a depigmentation agent and a sunscreen or a depigmentation agent plus a retinoid and a steroid and/or sunscreen. A chi square analysis was performed to determine whether or not each ethnic group was more or less likely to receive medication or a procedure.
RESULTS
There were approximately 24.7 million outpatient visits for dyschromia during an 18-year period from 1993 to 2010. Of 5,510,000 people with the sole diagnosis of dyschromia, 76% were seen by a dermatologist and more than half the population
was female. The number of visits for dyschromia seen by a dermatologist increased only by 1.1% over time (P=0.0004). The percentage of visits for dyschromia that were made by African-Americans or Hispanics did not significantly increase over time (P=0.3, P=0.4). The most common age group was 45-54 years old and the second most common was 55-64 years of age (Table 1). The average age of patients being seen by a physician for dyschromia is increasing over time (P=0.01). Caucasians comprised 75% of the total visits for dyschromia. Considering the number of visits per 100,000 population, Caucasian patients consisted of 1,800, African Americans comprised 1,600, Asian/Pacific Islander/Native Hawaiian made 3,800, and Hispanic patients consisted of 1,400 visits (Table 1). Over half of the population had private insurance (62%), while others had Medicare (9%) or self-pay (17%).
Top medications prescribed by dermatologists for the sole diagnosis of dyschromia include hydroquinone, topical corticosteroids,
and retinoids (Table 2). Treatments were somewhat similar in the white, black and Asian groups, in which topical corticosteroids
were either first or second most common across all groups. In blacks, topical corticosteroid was prescribed 93 % of the time and in white and Asian groups, it was prescribed over
50% of the time (Tables 3-5). Hydroquinone was also a common treatment among all groups. In whites, blacks, and Asians, hydroquinone was prescribed 950,000, 270,000, and 130,000 times, respectively (Tables 3-5). Topical retinoid was the most common treatment for dyschromia in Asians, which was prescribed 75 % of the time (Table 5). Treatment differed in the frequency of sunscreen given to whites compared with black or Asian patients. Sunscreen was the third most common treatment for dyschromia
in whites (32%), the sixth most common treatment in blacks (17 %), and the tenth most common treatments in Asians (7%).
