Gupta Aditya K, Economopoulos Vasiliki, Wang Tong, Piguet Vincent
Division of Dermatology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Mediprobe Research Inc., London, Ontario, Canada.
PLoS One. 2025 Jan 14;20(1):e0316681. doi: 10.1371/journal.pone.0316681. eCollection 2025.
Onychomycosis is a common, difficult to treat nail disorder. Our objective was to explore disparities in current clinical management practices for onychomycosis in patients from underrepresented groups and with specific comorbidities. We conducted a cross-sectional study using the All of Us (AoU) research program. The AoU program gathers survey, and electronic health records from participants in the United States with the aim of increasing the representation of minorities groups in health research under the framework of precision medicine. We identified 18,763 onychomycosis patients (2017-2022) and compared the rates of diagnostic testing, prescription medications and surgical procedures. Younger patients were more likely to receive oral medications, while older patients were more likely to undergo surgical nail procedures. Patients with lower income and education, Black and Hispanic patients were less likely to receive testing to confirm diagnosis, and less likely to receive prescription medications (topical and/or oral) except in the case of fluconazole. Lower income and education were associated with a higher likelihood of debridement and trimming procedures, while Black and Hispanic patients were less likely to undergo these procedures. Patients with disabilities also received different treatments when compared to able-bodied individuals, being less likely to receive ciclopirox, efinaconazole and terbinafine, but more likely to undergo debridement and trimming procedures. There are clear differences in the management of onychomycosis in the different demographic and comorbid populations that we studied. Efforts to reduce these inequalities, such as expanded health coverage, reducing communication barriers and increasing patient and physician education are needed.
甲癣是一种常见且难以治疗的指甲疾病。我们的目的是探讨在目前针对代表性不足群体以及患有特定合并症的患者的甲癣临床管理实践中存在的差异。我们使用“我们所有人”（AoU）研究项目进行了一项横断面研究。AoU项目收集来自美国参与者的调查和电子健康记录，目的是在精准医学框架下增加少数群体在健康研究中的代表性。我们确定了18763例甲癣患者（2017 - 2022年），并比较了诊断检测、处方药和外科手术的比例。年轻患者更有可能接受口服药物治疗，而老年患者更有可能接受指甲外科手术。收入和教育水平较低的患者、黑人和西班牙裔患者接受确诊检测的可能性较小，除氟康唑外，接受处方药（局部和/或口服）治疗的可能性也较小。收入和教育水平较低与清创和修剪手术的可能性较高相关，而黑人和西班牙裔患者接受这些手术的可能性较小。与身体健全的个体相比，残疾患者也接受了不同的治疗，他们接受环吡酮、艾氟康唑和特比萘芬的可能性较小，但接受清创和修剪手术的可能性较大。在我们研究的不同人口统计学和合并症人群中，甲癣的管理存在明显差异。需要努力减少这些不平等现象，例如扩大医保覆盖范围、减少沟通障碍以及加强患者和医生教育。
