Non-White vs. White Dermatitis visits across Age, Sex, Specialty, and Insurance status

Joseph Fahmy, Tammy Gonzalez PhD, Alan Fleischer , MD.

Department of Dermatology, University of Cincinnati, Cincinnati , Ohio

 

Introduction: Dermatological conditions are misdiagnosed in skin of color due to differences in presentation and morphology. Dermatitis is a broad and general conditions that encompasses multiple sub-types that can present as a variety of morphologies across different skin colors such as dry, itchy, or blistered skin. The goal of this study was to determine if the diagnosis of atopic dermatitis differed between racial groups as well as between age, sex, and insurance status. Treatment choice between the newer calcineurin inhibitors, such as tacrolimus or pimecrolimus, and traditional corticosteroids was also a focus of the study.

Methods:

This study utilizes data from the National Ambulatory Medical Care Survey (NAMCS) from 2012 to 2016. Visits with a diagnosis of atopic dermatitis, contact dermatitis, or unspecified dermatitis were selected by International Classification of Diseases, Ninth or Tenth Revision (ICD-9/ICD-10) classification. These visits were then differentiated further into Non- White and White visits based off the same ICD classification. Statistical analysis was then performed on the data using SAS software to determine what differences, if any, may exist and their significance.

 

Results: Of 7,263 atopic dermatitis, contact dermatitis, and unspecified dermatitis visits, Non-White populations consisted of 20.8% of the study population and White populations made up the other 79.2%. Bivariate analysis reveals that Non-White populations are less likely to receive diagnoses of Contact Dermatitis (CD) or Dermatitis Unspecified (DU) than a diagnosis of Atopic Dermatitis (AD) when compared to White populations. There is an increased likelihood for Non-White populations to be seen for dermatitis by Primary Care Physicians or physicians of other specialties than being seen by a dermatologist when compared to White populations. It also indicated that Non-White populations are less likely to use private insurance at dermatitis visits than using public or other forms of insurance such as cash or worker’s compensation than White populations.

Conclusions:

The decreased diagnosis of the other sub-types of dermatitis versus Atopic Dermatitis could mean that physicians are not well-equipped to diagnose skin of color correctly and are defaulting to AD diagnoses. This can be possibly be explained by the lower likelihood to be seen by a dermatologist who will be better trained for all presentations of dermatitis. There is also the implication that Non-White populations directly have less access to ever seeing a dermatologist. This can be attributed to long waits for appointments as well as a potential for Non-White populations having their insurance denied as it is less likely to be private. There is a case to be made for increasing PCP dermatological training as they often serve as frontline care for skin conditions as well as improving ease of access to dermatologists.

 

 

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