Bell Michael A, Whang Katherine A, Thomas Jamael, Aguh Crystal, Kwatra Shawn G
Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; School of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
J Natl Med Assoc. 2020 Dec;112(6):650-653. doi: 10.1016/j.jnma.2020.06.009. Epub 2020 Jul 5.
This study investigates possible race- and ethnicity-related disparities in the treatment of acne, atopic dermatitis, and psoriasis of newly approved treatments as well as existing therapies.
Aggregate level data was collected from patient medical records between 2013 and 2018. The odds ratio of patients who had been prescribed treatments for acne, atopic dermatitis, and psoriasis per racial and ethnic group were calculated using a 95% confidence interval after applying Bonferroni correction to account for multiple comparisons.
Black patients with acne had statistically significant (p < 0.001) lower odds of receiving isotretinoin 0.26 [0.22-0.30], adapalene 0.72 [0.67-0.78], tazarotene 0.74 [0.64-0.86], and dapsone 0.39 [0.34-0.45] than white patients. The exceptions were tretinoin 1.28 [1.23-1.34] and benzoyl peroxide 3.00 [2.79-3.23] (p < 0.001). Hispanic patients with acne had statistically lower odds of receiving tretinoin 0.86 [0.79-0.95] (p < 0.001) compared to non-Hispanics. Black patients with atopic dermatitis were less likely to receive desonide 0.90 [0.78-0.93], tacrolimus 0.75 [0.68-0.83], pimecrolimus 0.71 [0.60-0.84], crisaborole 0.39 [0.26-0.57], dupilumab 0.42 [0.27-0.65]. The exception was hydrocortisone 2.50 [2.34-2.65] (p < 0.001). There was no statistically significant difference for Hispanics compared to non-Hispanics. Black patients with psoriasis had a lower likelihood of receiving cyclosporine 0.54 [0.35-0.83] and etanercept 0.65 [0.49-0.87].
This study demonstrates a racial and ethnic disparity in accessing newly approved and standard of care medical therapies for acne, atopic dermatitis, and psoriasis within the past three years.
本研究调查了在痤疮、特应性皮炎和银屑病的治疗中，新批准的治疗方法以及现有疗法可能存在的与种族和民族相关的差异。
收集了2013年至2018年患者病历中的汇总数据。在应用Bonferroni校正以考虑多重比较后，计算每个种族和民族组中接受痤疮、特应性皮炎和银屑病治疗的患者的优势比，并使用95%置信区间。
患有痤疮的黑人患者接受异维A酸的几率显著较低（p < 0.001），为0.26 [0.22 - 0.30]，阿达帕林为0.72 [0.67 - 0.78]，他扎罗汀为0.74 [0.64 - 0.86]，氨苯砜为0.39 [0.34 - 0.45]，低于白人患者。例外情况是维甲酸为1.28 [1.23 - 1.34]，过氧化苯甲酰为3.00 [2.79 - 3.23]（p < 0.001）。与非西班牙裔患者相比，患有痤疮的西班牙裔患者接受维甲酸的几率在统计学上较低，为0.86 [0.79 - 0.95]（p < 0.001）。患有特应性皮炎的黑人患者接受地奈德的可能性较小，为0.90 [0.78 - 0.93]，他克莫司为0.75 [0.68 - 0.83]，吡美莫司为0.71 [0.60 - 0.84]，克立硼罗为0.39 [0.26 - 0.57]，度普利尤单抗为0.42 [0.27 - 0.65]。例外情况是氢化可的松为2.50 [2.34 - 2.65]（p < 0.001）。与非西班牙裔患者相比，西班牙裔患者没有统计学上的显著差异。患有银屑病的黑人患者接受环孢素的可能性较低，为0.54 [0.35 - 0.83]，接受依那西普的可能性较低，为0.65 [0.49 - 0.87]。
本研究表明，在过去三年中，在获得痤疮、特应性皮炎和银屑病的新批准和标准护理医疗疗法方面存在种族和民族差异。
