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Original Investigation
February 5, 2020

Association of Race/Ethnicity and Sex With Differences in Health Care Use and Treatment for Acne

Author Affiliations
  • 1Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
  • 2Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
JAMA Dermatol. Published online February 5, 2020. doi:10.1001/jamadermatol.2019.4818
Key Points

Question  Are race/ethnicity and sex associated with differences in health care use and prescribing patterns among patients with acne?

Findings  In this cohort study of 29 928 patients with acne, compared with non-Hispanic white patients, non-Hispanic black patients were more likely to be prescribed topical retinoids or topical antibiotics and less likely to receive prescriptions for oral antibiotics, spironolactone, and isotretinoin. Male patients were more likely to be prescribed isotretinoin than female patients; patients with Medicaid were less likely to receive prescriptions for topical retinoids and systemic therapies.

Meaning  The findings suggest that there may be racial/ethnic, sex, and insurance-based disparities in health care use and treatment for acne.

Abstract

Importance  Our understanding of potential racial/ethnic, sex, and other differences in health care use and treatment for acne is limited.

Objective  To identify potential disparities in acne care by evaluating factors associated with health care use and specific treatments for acne.

Design, Setting, and Participants  This retrospective cohort study used the Optum deidentified electronic health record data set to identify patients treated for acne from January 1, 2007, to June 30, 2017. Patients had at least 1 International Classification of Diseases, Ninth Revision (ICD-9) or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) code for acne and at least 1 year of continuous enrollment after the first diagnosis of acne. Data analysis was performed from September 1, 2019, to November 20, 2019.

Main Outcomes and Measures  Multivariable regression was used to quantify associations between basic patient demographic and socioeconomic characteristics and the outcomes of health care use and treatment for acne during 1 year of follow-up.

Results  A total of 29 928 patients (median [interquartile range] age, 20.2 [15.4-34.9] years; 19 127 [63.9%] female; 20 310 [67.9%] white) met the inclusion criteria for the study. Compared with non-Hispanic white patients, non-Hispanic black patients were more likely to be seen by a dermatologist (odds ratio [OR], 1.20; 95% CI, 1.09-1.31) but received fewer prescriptions for acne medications (incidence rate ratio, 0.89; 95% CI, 0.84-0.95). Of the acne treatment options, non-Hispanic black patients were more likely to receive prescriptions for topical retinoids (OR, 1.25; 95% CI, 1.14-1.38) and topical antibiotics (OR, 1.35; 95% CI, 1.21-1.52) and less likely to receive prescriptions for oral antibiotics (OR, 0.80; 95% CI, 0.72-0.87), spironolactone (OR, 0.68; 95% CI, 0.49-0.94), and isotretinoin (OR, 0.39; 95% CI, 0.23-0.65) than non-Hispanic white patients. Male patients were more likely to be prescribed isotretinoin than female patients (OR, 2.44; 95% CI, 2.01-2.95). Compared with patients with commercial insurance, those with Medicaid were less likely to see a dermatologist (OR, 0.46; 95% CI, 0.41-0.52) or to be prescribed topical retinoids (OR, 0.82; 95% CI, 0.73-0.92), oral antibiotics (OR, 0.87; 95% CI, 0.79-0.97), spironolactone (OR, 0.50; 95% CI, 0.31-0.80), and isotretinoin (OR, 0.43; 95% CI, 0.25-0.75).

Conclusions and Relevance  The findings identify racial/ethnic, sex, and insurance-based differences in health care use and prescribing patterns for acne that are independent of other sociodemographic factors and suggest potential disparities in acne care. In particular, the study found underuse of systemic therapies among racial/ethnic minorities and isotretinoin among female patients with acne. Further study is needed to confirm and understand the reasons for these differences.

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