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美国患有慢性炎症性皮肤病的成年人在就医障碍方面的种族和族裔差异:“我们所有人”研究计划的横断面研究

Racial and ethnic differences in barriers to care among US adults with chronic inflammatory skin diseases: A cross-sectional study of the All of Us Research Program.

作者信息

Nock Michael R, Barbieri John S, Krueger Loren D, Cohen Jeffrey M

机构信息

Department of Dermatology, Yale School of Medicine, New Haven, Connecticut.

Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.

出版信息

J Am Acad Dermatol. 2023 Mar;88(3):568-576. doi: 10.1016/j.jaad.2022.09.054. Epub 2022 Oct 13.

Abstract

BACKGROUND

Research on racial and ethnic differences in barriers to care among patients with chronic inflammatory skin diseases (CISDs) is limited.

OBJECTIVE

To investigate the prevalence of a broad range of barriers to care among patients with CISDs across different racial and ethnic groups.

METHODS

A cross-sectional study was conducted using survey data from participants with CISDs in the All of Us Research Program. Multivariable regression was used to analyze the relationship between race and ethnicity and experiencing barriers to care.

RESULTS

Our study included 16,986 patients with CISDs. Compared to White patients, Black and Hispanic patients were significantly more likely to delay care because of cost and a broad range of additional structural barriers, including transportation, work, childcare, adult care, living in a rural area, and the lack of health care workforce diversity. However, associations between race and ethnicity and many barriers to care were substantially attenuated after controlling for insurance, income, and education.

LIMITATIONS

The population studied was not a representative sample of US adults, and responses were not specific to dermatologic care.

CONCLUSION

Racial and ethnic minority patients with CISDs, especially Black and Hispanic patients, are disproportionately affected by a broad range of barriers to care.

摘要

背景

关于慢性炎症性皮肤病(CISD)患者在就医障碍方面的种族和族裔差异的研究有限。

目的

调查不同种族和族裔群体中CISD患者广泛存在的就医障碍的患病率。

方法

利用“我们所有人”研究项目中CISD参与者的调查数据进行横断面研究。采用多变量回归分析种族和族裔与就医障碍之间的关系。

结果

我们的研究纳入了16986例CISD患者。与白人患者相比,黑人和西班牙裔患者因费用以及包括交通、工作、儿童照料、成人照料、居住在农村地区和缺乏医疗保健劳动力多样性等一系列额外的结构性障碍而显著更有可能推迟就医。然而,在控制了保险、收入和教育因素后,种族和族裔与许多就医障碍之间的关联大幅减弱。

局限性

所研究的人群并非美国成年人的代表性样本,且回答并非针对皮肤科护理。

结论

患有CISD的种族和族裔少数群体患者,尤其是黑人和西班牙裔患者,受到广泛就医障碍的影响尤为严重。

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