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Association of Demographic and Socioeconomic Characteristics With Differences in Use of Outpatient Dermatology Services in the United States
Open accessAbstract
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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“Racial and ethnic disparities in skin cancer mortality often result from delayed diagnosis, which may arise from underutilization of dermatologic care [75, 76] and differences in the clinical presentation of skin cancer among SOC patients.”
From Photoprotection for skin of color (2022) · cites this paper as [76]
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Racial disparities in dermatology
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Metadata
- 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
- Venue
- JAMA Dermatology
- Publisher
- American Medical Association (AMA)
- Published
- 2018-11-01
- Volume
- 154
- Issue
- 11
- Pages
- 1286
- ISSN
- 2168-6068 (ISSN-L)
- 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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