Language proficiency and biologics access: a population study of psoriasis patients in the United States.

BACKGROUND: Language proficiency plays an important role in healthcare choices and access. Differences in access to biologic medications exist, but it is unknown how much English proficiency influences access in US psoriasis patients. OBJECTIVE: To compare biologic medication use for psoriasis patients with differing English proficiency levels. METHODS: Population study of US psoriasis patients using the 2013-2017 Medical Expenditure Survey. RESULTS: Among a total of 4,470,820 US psoriasis patients (weighted), 4,028,119 (90.1%) had perfect English proficiency, and 442,700 (9.9%) had less than perfect English proficiency. Among the total population, 422,523 (9.5%) had access to biologics. Among those who received biologics, 411,411 (97.4%) of those had perfect English proficiency, and 11,112 (2.6%) of those had less than perfect English proficiency. Multivariate logistic regression found that patients with less than perfect English proficiency were significantly less likely to have access to biologics [OR 0.015 (95% CI: 0.001-0.179); p = .002], after adjusting for insurance status, income, education, healthcare utilization, and other sociodemographic and clinical factors. LIMITATIONS: Psoriasis disease severity not specified. CONCLUSIONS: Psoriasis patients with low English proficiency are significantly less likely to receive biologics than those with high English proficiency. Those with higher English proficiency are 61 times more likely to access biologics.

Differences in health care resource utilization and costs for keratinocyte carcinoma among racioethnic groups: A population-based study.

BACKGROUND: As the United States becomes more diverse, determining differences in health care utilization and costs in the management of skin cancers is fundamental to decision-making in health care resource allocation and improving care for underserved populations. OBJECTIVE: To compare health care use and costs among non-Hispanic White, Hispanic White, and non-Hispanic Black patients with keratinocyte carcinoma. METHODS: A nationwide cross-sectional study was performed using Medical Expenditure Panel Survey data from 1996 to 2015. RESULTS: Among 54,503,447 patients with keratinocyte carcinoma (weighted) over a 20-year period, 53,134,351 (97%) were non-Hispanic White; 836,030 (1.5%) were Hispanic White; and 170,755 (0.3%) were non-Hispanic Black. Compared to non-Hispanic White patients, Hispanic White patients had significantly more ambulatory visits per person per year (5.4 vs 3.5, P = .003). Compared to non-Hispanic White patients, non-Hispanic Black patients had significantly more ambulatory visits (13.1 vs 3.5, P = .027) and emergency department visits (2.3 vs 1.1, P < .001), and incurred significantly higher ambulatory costs ($5089 vs $1131, P = .05), medication costs ($523 vs $221, P = .022), and total costs per person per year ($13,430 vs $1290, P = .032). LIMITATIONS: Data for squamous cell carcinomas and basal cell carcinomas are combined. CONCLUSIONS: Keratinocyte carcinoma was more costly to treat and required more health care resources in non-Hispanic Black and Hispanic White patients than in non-Hispanic White patients.

Differences in Depression and Distress Between Acne Patients on Isotretinoin vs Oral Antibiotics.

BACKGROUND: Little is known regarding differential effects of systemic anti-acne treatments on mental health. OBJECTIVE: To determine whether differences exist in mental health outcomes between acne patients treated with isotretinoin versus oral antibiotics (doxycycline, minocycline, or tetracycline). METHODS: Population study utilizing the 2004-2017 Medical Expenditure Panel Survey. Depressive symptoms were assessed using Patient Health Questionnaire 2 (PHQ-2); psychological distress was measured by the Kessler 6-Item Psychological Distress Scale (K6). Acne patients completed both the PHQ-2 and K6 during treatment with isotretinoin or oral antibiotics. Lower scores on both measures indicate better mental health outcomes. RESULTS: After adjusting for socio-demographic characteristics, patients on isotretinoin had fewer depressive symptoms than patients on oral antibiotics, as measured by mean PHQ-2 scores (isotretinoin 0.280 vs oral antibiotics 0.656, difference=0.337, P<0.01). The adjusted comparison also showed patients on isotretinoin had less psychological distress than patients on oral antibiotics, as measured by K6 scores (isotretinoin 2.494 vs oral antibiotics 3.433, difference=0.759, P=0.043). LIMITATIONS: No direct assessment of acne severity. CONCLUSION: Acne patients on isotretinoin experienced less depressive symptoms and psychological distress as compared to oral antibiotics. J Drugs Dermatol. 2021;20(2):172-177. doi:10.36849/JDD.5559.