Cited by 158Health disparities and outcomesHealthcare Policy and ManagementDermatology and Skin Diseases

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Association of Demographic and Socioeconomic Characteristics With Differences in Use of Outpatient Dermatology Services in the United States

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Tripathi, Raghav, Knusel, Konrad D., Ezaldein, Harib H., Scott, Jeffrey F., Bordeaux, Jeremy S.·2018·JAMA Dermatology

DOI 10.1001/jamadermatol.2018.3114PMC PMC6248122

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Abstract

Importance: Knowledge regarding differences in dermatologic care for patients with a broad range of dermatologic conditions is limited. Objective: To elucidate nationwide differences in use of outpatient dermatologic care. Design, Setting, and Participants: Retrospective analysis of nationally representative data from the 2007 to 2015 Medical Expenditure Panel Survey (MEPS) provided by the Agency for Healthcare Research and Quality. Health care use outcomes for dermatologic conditions (skin cancers, infections, dermatologic inflammatory conditions/ulcers, and other skin disorders) were examined via multivariable logistic regression analyses of outpatient and office-based dermatologist visit rates accounting for sex, age, race/ethnicity, educational level, income, insurance status, region, self-reported condition, and self-reported health status. Participants were 183 054 MEPS respondents who visited a dermatologist from 2007 to 2015. Main Outcomes and Measures: The primary outcome measure was whether the patient received outpatient care for any dermatologic condition (by payment). The secondary outcomes were annual health care use by individuals with dermatologic conditions (including per capita expenditure for the visit). Results: Of 183 054 MEPS respondents (mean [SD] age, 34 [23] years; 52.1% female), 19 561 (10.7%) self-reported a dermatologic condition; 9645 patients had a total of 11 761 outpatient visits to dermatologists. Hispanic (adjusted odds ratio [aOR], 0.55; 95% CI, 0.49-0.61) and black (aOR, 0.42; 95% CI, 0.38-0.46) patients were both less likely to receive outpatient care for their dermatologic condition relative to non-Hispanic white patients. Male patients were less likely to receive outpatient dermatologic care than female patients (aOR, 0.66; 95% CI, 0.62-0.70), and Midwestern patients were less likely to receive outpatient dermatologic care than Northeastern patients (aOR, 0.80; 95% CI, 0.70-0.91). Patients with Medicaid or Medicare coverage (aOR, 0.75; 95% CI, 0.68-0.83) and uninsured patients (aOR, 0.39; 95% CI, 0.33-0.47) were both less likely to receive outpatient dermatologic care than privately insured patients. Increasing educational level and income were associated with increased odds of receiving outpatient care for the dermatologic condition. Conclusions and Relevance: These findings highlight wide-ranging differences in use of dermatologic care in the United States across various demographic and socioeconomic lines. Results of this study suggest an urgent need to further characterize potential dermatologic health care differences and improve use of outpatient dermatologic care among disadvantaged populations.

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Authors: Tripathi, R., Knusel, K. D., Ezaldein, H. H., Scott, J. F., & Bordeaux, J. S.
Affiliations: University Hospitals Cleveland Medical Center (US)
Corresponding author: Tripathi, Raghav
ORCID: Tripathi, Raghav
Knusel, Konrad D.
Ezaldein, Harib H.
Scott, Jeffrey F.
Bordeaux, Jeremy S.
Venue: JAMA Dermatology
Publisher: American Medical Association (AMA)
Published: 2018-11-01
Volume: 154
Issue: 11
Pages: 1286
ISSN: 2168-6068 (ISSN-L)
DOI: 10.1001/jamadermatol.2018.3114
PMC: PMC6248122
OpenAlex: W2893715656
Cited by: 158
References: 25
Citations by year: 2026: 16 · 2025: 32 · 2024: 22 · 2023: 25 · 2022: 27 · 2021: 14 · 2020: 17 · 2019: 3 · 2018: 1
FWCI: 9.37
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: JAMA Dermatology (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Health › Health disparities and outcomes
Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
Health Sciences › Medicine › Dermatology › Dermatology and Skin Diseases
Keywords: dermatological care, health care utilization disparities, socioeconomic status, racial and ethnic disparities, Hispanic patients, Black patients, Medicaid, Medicare, uninsured patients, skin cancer, skin infections, regional variation in care, health care expenditure, self-rated health, Medical Expenditure Panel Survey
MeSH terms: Adolescent, Adult, Aged, Ambulatory Care, Female, Follow-Up Studies, Health Services Accessibility, Humans, Insurance, Health, Male, Middle Aged, Office Visits, Outpatients, Retrospective Studies, Skin Diseases, Socioeconomic Factors, United States, Insurance Coverage, Young Adult

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Association of Demographic and Socioeconomic Characteristics With Differences in Use of Outpatient Dermatology Services in the United States

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