Trends in Older Adult Psoriasis Outpatient Health Care Practices in the United States

August 2012 | Volume 11 | Issue 8 | Original Article | 957 | Copyright © August 2012


Jillian W. Wong MS,a,b Scott A. Davis MA,c Steven R. Feldman MD PhD,c,d,e and John Y. M. Koo MDb

aUniversity of Utah School of Medicine, Salt Lake City, UT bDepartment of Dermatology, UCSF Psoriasis and Skin Treatment Center, San Francisco, CA Wake Forest School of Medicine, Center for Dermatology Research, Departments of cDermatology, dPathology, and ePublic Health Sciences, Winston-Salem, NC

Abstract
Background: Psoriasis is among the top dermatologic diagnoses for older adult patients, and the number of older adult psoriasis patients is expected to rise.
Purpose: To characterize trends in older adult psoriasis health care practices of US ambulatory physician offices from 1993 to 2009.
Methods: We used data from the National Ambulatory Medical Care Survey to assess demographics, specialties seen, and treatment in visits by older adult patients, 55 years of age and older.
Results: There were approximately 14.1 million outpatient visits for psoriasis among the older adult population during the study period. Older adult psoriasis patients were 52.4% female and 47.6% male. The most frequent older adult age group seen for psoriasis was the 55 to 64 year age group. Dermatologists saw 69.3% of patients, internists saw 14.5%, and general and family practitioners saw 11.6%. Topical corticosteroids were the most frequently prescribed medications. Dermatologists preferred clobetasol whereas non-dermatologists more commonly prescribed betamethasone. For both the 18 to 54 year age group and the 55 and older group, the leading 7 out of 10 medications prescribed were topical corticosteroids and calcipotriene. However, etanercept, coal tar, and fluocinolone were among the leading medications in the younger group but not in the 55 and older group.
Conclusions: Treatment approach for older adult psoriasis patients showed some differences among medical specialties and among the younger and older age groups. Further research specific to older adult psoriasis patients is needed to determine optimal treatment strategies for this patient population.

J Drugs Dermatol. 2012;11(8):957-962.

INTRODUCTION

As the baby-boomer generation (born between 1945 to 1965) has aged, the older adult population has become a prominent age group in the United States (US) and is expected to continue to rise in the future.1 In 2009, it was estimated that 21% of the US population (60 million) was 55 years of age or older, and it is estimated that this group will constitute 31% of the US population (107.6 million) by 2030.2 Therefore, care of older adult patients in dermatology clinics has become more important, including those with psoriasis.
Psoriasis is a chronic, inflammatory skin disease that affects approximately 2.5% of the US population.3-5 Although the prevalence of psoriasis in the older adult population, described here as individuals 55 years of age and older, is unknown, a US population- based study showed that psoriasis has the highest rate of occurrence in the 60 to 69 year age group compared to younger age groups (113/100,000 population).6 Furthermore, psoriasis is among the top dermatologic diagnoses for older adult patients seeking ambulatory care.7 Given the chronicity of the disease, older adult psoriasis patients are expected to increase in the future. Furthermore, a recent study of 4,049 psoriasis patients in Korea showed differences in elderly-onset psoriasis, in which onset occurred after 60 years of age, in terms of disease course, anatomical site of origin, and clinical phenotypes.8
Management of psoriasis in older adult patients can be challenging as a result of the paucity of data specific to this population and subsequent lack of consensus guidelines specific to older adults. Therefore, we sought to characterize the trends in health care practices for older adult patients with psoriasis in the US from 1993 to 2009.

METHODS

We collected data from the National Ambulatory Medical Care Survey (NAMCS) to evaluate US outpatient visits for older adult patients with psoriasis ages 55 and older. The NAMCS is performed by the National Center for Health Statistics (NCHS) as an annual survey of non-federally employed outpatient physicians in all specialties directly involved in patient care. Annually, the NCHS obtains a representative sample of patient visits first by randomly selecting a subset of physicians, randomly choosing one week of that physician's practice in the specified year,
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