Richardson Hermione, Basnet Sunima, Rad Deniz, Vijayan Roshan
University of Cambridge, School of Clinical Medicine, United Kingdom.
East & North Hertfordshire NHS Trust, Lister Hospital, Coreys Mill Lane, Stevenage SG1 4AB, United Kingdom.
JPRAS Open. 2025 May 6;45:136-147. doi: 10.1016/j.jpra.2025.04.014. eCollection 2025 Sep.
Keloid scars, which are significantly more common in ethnic minorities, are challenging to treat in England because of funding policies. Overly restrictive funding criteria can have a disproportionate adverse effect on those most prone to keloid, resulting in health inequality.
This cross-sectional study investigated the regional variations in funding criteria for keloid scar surgery across the 42 integrated care boards (ICBs) of England and, through Freedom of Information requests, the number of corresponding applications and approvals in 2023. Potential associations with the Black, Asian and minority ethnic composition of ICB populations were explored.
Funding criteria were highly restrictive across all ICBs. Keloid scar surgery applications were almost universally low, with some ICBs reporting <5 or no applications. Acceptance rates were generally low. There was no significant overall correlation between the ethnic proportion of ICBs' populations and number of applications or approval rates.
Our findings confirmed that access to keloid surgery is highly restricted nationwide, a situation that likely disproportionately disadvantages the ethnic minorities. The near total lack of ethnicity data collection by ICBs obstructs the full characterisation of this issue. We propose exempting keloids from funding restrictions or at least revising the criteria to account for their symptomatic and psychosocial impact, to help achieve more equitable healthcare policies.
瘢痕疙瘩在少数民族中更为常见，由于资金政策，在英国治疗具有挑战性。过于严格的资金标准可能会对最易患瘢痕疙瘩的人群产生不成比例的不利影响，导致健康不平等。
这项横断面研究调查了英格兰42个综合护理委员会（ICB）中瘢痕疙瘩手术资金标准的区域差异，并通过信息自由请求，了解了2023年相应申请和批准的数量。探讨了与ICB人群中黑人、亚洲人和少数族裔构成的潜在关联。
所有ICB的资金标准都非常严格。瘢痕疙瘩手术申请几乎普遍较少，一些ICB报告的申请数少于5例或没有申请。接受率普遍较低。ICB人群的种族比例与申请数量或批准率之间没有显著的总体相关性。
我们的研究结果证实，全国范围内瘢痕疙瘩手术的可及性受到高度限制，这种情况可能会对少数民族造成不成比例的不利影响。ICB几乎完全缺乏种族数据收集，这妨碍了对该问题的全面描述。我们建议免除瘢痕疙瘩的资金限制，或至少修订标准以考虑其症状和心理社会影响，以帮助实现更公平的医疗政策。
