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Original Investigation
November 2018

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

Author Affiliations
  • 1Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio
  • 2Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
JAMA Dermatol. 2018;154(11):1286-1291. doi:10.1001/jamadermatol.2018.3114
Key Points

Question  What differences in use of dermatologic care exist in the United States between demographic and socioeconomic groups?

Findings  Among 183 054 Medical Expenditure Panel Survey respondents, Hispanic and black patients were less likely to receive outpatient dermatologic care than non-Hispanic white patients. Patients who were male, uninsured, Midwestern, from a lower income group, had a lower educational level, or had Medicaid or Medicare coverage were less likely to receive outpatient dermatologic care.

Meaning  Differences in sex, race/ethnicity, insurance status, region, and socioeconomic characteristics exist in use of dermatologic care in the United States; there is a need to further characterize potential differences in use of outpatient dermatologic care among disadvantaged populations.

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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