Desai Rini, Irwin Chase, McCune Mariana, Davis Mitchell
University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA.
Arch Dermatol Res. 2024 Dec 12;317(1):106. doi: 10.1007/s00403-024-03623-8.
The growing evidence of chronic inflammation and sequelae caused by psoriasis indicates the need for systemic treatment, including biologics and conventional treatments like methotrexate. However, unconscious racial bias may lead to discrepancies in systemic medication prescription. Racial identity is also suspected to affect comorbidity and hospitalization rates in patients with psoriasis. This study examines the impact of race on hospitalization duration and systemic medication prescription patterns in patients with psoriasis in the United States in 2020. The 2020 Healthcare Cost and Utilization (HCUP) National Inpatient Sample (NIS) database was used, with inpatient admissions over the age of 17 with an ICD-10-coded psoriasis diagnosis included. Patient demographics and hospital characteristics were compared between "non-white" and "white" patients, with white patients as the reference group. The primary outcome, systemic medication prescription, was evaluated using logistic regression models, producing an odds ratio and corresponding 95% confidence interval (CI). The secondary outcome, length of stay, was evaluated using negative binomial regression models to approximate the incident rate ratio and 95% CI. 1,802,720 patients with psoriasis were included in this study. Hispanic, Asian or Pacific Islander, and Native American patients with psoriasis had significantly lower odds of systemic medication prescription than white patients with psoriasis. All non-white racial identities were found to have significantly longer estimated lengths of stay compared to white patients with psoriasis. Disparities in the medication of choice for psoriasis treatment can lead to increased inpatient burden with longer lengths of stay for non-white patients.
越来越多的证据表明，银屑病会引发慢性炎症和后遗症，这表明需要进行全身治疗，包括使用生物制剂和甲氨蝶呤等传统治疗方法。然而，无意识的种族偏见可能导致全身用药处方出现差异。种族身份也被怀疑会影响银屑病患者的合并症和住院率。本研究调查了种族对2020年美国银屑病患者住院时间和全身用药处方模式的影响。研究使用了2020年医疗成本与利用情况（HCUP）全国住院患者样本（NIS）数据库，纳入了年龄在17岁以上、国际疾病分类第十版（ICD-10）编码为银屑病诊断的住院患者。以白人患者为参照组，比较了“非白人”和“白人”患者的人口统计学特征和医院特征。主要结局指标全身用药处方，采用逻辑回归模型进行评估，得出比值比及相应的95%置信区间（CI）。次要结局指标住院时间，采用负二项回归模型进行评估，以近似发病率比及95%CI。本研究纳入了1,802,720例银屑病患者。西班牙裔、亚裔或太平洋岛民以及美国原住民银屑病患者接受全身用药处方的几率显著低于白人银屑病患者。与白人银屑病患者相比，所有非白人种族身份的患者预计住院时间均显著更长。银屑病治疗用药选择上的差异可能导致非白人患者住院负担增加，住院时间延长。
