including Alaska Native, Native American, and multiple races. Among all psoriasis patients, 3,026,578 (9.6%) were prescribed biologics. Among those who received biologics, 2,778,239 (91.8%) identified as white, 84,971 (2.8%) identified as Black, 89,452 (3.0%) identified
as Asian, and 73,917 (2.4%) identified
as Asian, and 73,917 (2.4%) identified
as other races. The adjusted multivariate regression analysis revealed no racial differences in biologics access compared with whites (OR for Blacks: 0.347 [0.118, 1.021], P=0.055; OR for Asians: 0.616 [0.240, 1.579], P=0.311; OR for other races: 0.850 [0.216, 3.336], P=0.814; Table 1).
Our study revealed no significant association between race and biologic access among US psoriasis patients. Our results differ from our a priori hypothesis and previous studies that demonstrated certain races were less likely to receive biologics for treatment of their psoriasis.9,11 The differences in findings between this study and previous findings might be attributable, at least in part, to the patient populations. This study uses Medical Expenditure Panel Survey (MEPS), which draws on a nationally representative sample of adult and pediatric patients over a 15-year time span. We also adjusted for possible contributory factors including ethnicity, insurance status, and poverty level with no significant differences found across all racial groups.
Biologics remain one of the most effective treatment options for psoriasis. While access to biologics does not appear to be significantly different between white and non-white racial groups, racial minorities experience more severe psoriasis and psychological burden than their white counterparts. This may lead to delayed diagnosis and subsequent more severe disease on initial presentation.2,5,6,12 Barriers to seeking dermatologist care for psoriasis among non-whites may include lack of cultural competency and low density of dermatology providers in areas where significant proportions of people of color reside.13,14 Socioeconomic and demographic factors, other than race, such as older age, poor English language proficiency, and lower income level, may also exacerbate access to biologics, and thus result in more severe disease.8,15 Further investigation is needed to elucidate potential additional demographic, socioeconomic, and clinical risk factors contributing to increased disease severity faced by minority patients.
DISCLOSURES
April W. Armstrong MD MPH has served as a research investigator and/or scientific advisor to AbbVie, Almirall, Arcutis, ASLAN, Beiersdorf, BI, BMS, EPI, Incyte, Leo, UCB, Janssen, Lilly, Nimbus, Novartis, Ortho Dermatologics, Sun, Dermavant, Dermira, Sanofi, Regeneron, Pfizer, and Modmed. All remaining authors have no disclosures.
REFERENCES
- Armstrong AW, Mehta MD, Schupp CW, et al. Psoriasis prevalence in adults in the United States. JAMA Dermatol. 2021;157(8):940-946.
- Gelfand JM, Stern RS, Nijsten T, et al. The prevalence of psoriasis in African Americans: results from a population-based study. J Am Acad Dermatol. 2005;52(1):23-26.
- Gonzalez T, Fleischer AB Jr. Increased biologic utilization in Latino patients with psoriasis. J Dermatolog Treat. 2022;33(2):965-968.
- Fischer AH, Shin DB, Gelfand JM, et al. Health care utilization for psoriasis in the United States differs by race: an analysis of the 2001-2013 Medical Expenditure Panel Surveys. J Am Acad Dermatol. 2018;78(1):200-203.
