Asian Psoriasis Patients Get Less Time With Dermatologists, Study SuggestsAugust 3, 2022
Asian patients with psoriasis receive less face-to-face time with dermatologists, according to a cross-sectional study.
Among over 4 million patient visits for psoriasis, mean duration of visit was 9.2 minutes for Asian patients compared with 15.7 minutes for Hispanic or Latino patients, 20.7 minutes for Black patients, and 15.4 minutes for white patients, reported April W. Armstrong, MD, MPH, and Kevin K. Wu, MD, both of the Keck School of Medicine at the University of Southern California in Los Angeles.
Visits with Asian patients had a 39.9% shorter mean duration versus visits with white patients (β coefficient -5.747, 95% CI -11.026 to -0.469, P=0.03) and a 40.6% shorter mean duration versus visits with non-Asian patients as a single group (β coefficient -5.908, 95% CI -11.147 to -0.669, P=0.03), they noted in a research letter published in JAMA Dermatology.
While these findings support previous research, “paradoxically, Asian individuals tend to present with more severe psoriasis compared with individuals of other races and ethnicities,” Armstrong and Wu pointed out.
“The etiology of these differences is unclear. It is possible that factors, such as unconscious bias, cultural differences in communication, or residual confounding may be responsible for the observed findings,” they wrote. “Further research is needed to understand the underlying factors responsible for the differences observed in this study.”
“Dermatologists have an obligation to provide each patient with psoriasis with adequate time to address their concerns and develop strong communication and trust,” they stressed. “Ineffective physician-patient communication can mean poor treatment adherence, comprehension, satisfaction, and outcomes for the patient.”
There were notable differences in the average age of psoriasis patients who had in-person visits with dermatologists among the different racial groups, the authors noted.
White patients, on average, were the oldest, at 54.8 years, followed by Hispanic or Latino patients at 44.7, Asian patients at 37.2, and Black patients at 33.3.
There were also differences in prescription of complex topical regimens among groups, with 11.8% of Asian patients receiving such treatments compared with 1.5% of Black patients and 1.1% of white patients.
Data were taken from the National Ambulatory Medical Care Survey from 2010 through 2016. Approximately 4,201,745 patient visits for psoriasis were included in the study. Generally, women were more likely to visit a dermatologist than men.
Analyses were adjusted for age, sex, type of visit (follow-up or new), visit complexity based on the number of reasons for visit, insurance status, psoriasis severity on the basis of systemic treatment or phototherapy, and use of complex topical regimens (three or more topical agents).
Armstrong and Wu noted several limitations to their study. Physicians or their staff self-reported visit durations, and race and ethnicity data that were missing were attributed using a sequential regression method. In addition, there may be other factors that affected length of visits.
Armstrong reported relationships with AbbVie, Regeneron, Bristol Myers Squibb, Dermavant, Dermira, Eli Lilly, Janssen, Novartis, UCB Pharma, Modernizing Medicine Ortho Dermatologics, Sanofi Genzyme, Sun Pharma, Pfizer, Almirall, Arcutis Biotherapeutics, ASLAN Pharmaceuticals, Beiersdorf, EPI Health, Incyte, Nimbus Therapeutics, Boehringer Ingelheim, and Parexel.
She is also on the editorial board of JAMA Dermatology, but she was not involved in any of the decisions regarding review of the manuscript or its acceptance.