Association of demographic and socioeconomic characteristics with differences in use of outpatient dermatology services in the United States

Raghav Tripathi, Konrad D. Knusel, Harib H. Ezaldein, Jeffrey Scott, Jeremy S. Bordeaux

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)1286-1291
Number of pages6
JournalJAMA Dermatology
Volume154
Issue number11
DOIs
StatePublished - Nov 1 2018
Externally publishedYes

Fingerprint

Ambulatory Care
Dermatology
Demography
Odds Ratio
Health Expenditures
Delivery of Health Care
Outpatients
Outcome Assessment (Health Care)
Skin Ulcer
Insurance Coverage
Health Services Research
Medicaid
Skin Neoplasms
Vulnerable Populations
Medicare
Hispanic Americans
Health Status
Patient Care
Logistic Models
Regression Analysis

ASJC Scopus subject areas

  • Dermatology

Cite this

Association of demographic and socioeconomic characteristics with differences in use of outpatient dermatology services in the United States. / Tripathi, Raghav; Knusel, Konrad D.; Ezaldein, Harib H.; Scott, Jeffrey; Bordeaux, Jeremy S.

In: JAMA Dermatology, Vol. 154, No. 11, 01.11.2018, p. 1286-1291.

Research output: Contribution to journalArticle

Tripathi, Raghav ; Knusel, Konrad D. ; Ezaldein, Harib H. ; Scott, Jeffrey ; Bordeaux, Jeremy S. / Association of demographic and socioeconomic characteristics with differences in use of outpatient dermatology services in the United States. In: JAMA Dermatology. 2018 ; Vol. 154, No. 11. pp. 1286-1291.
@article{8a654bed3b464c5e9f322a7ba7d5cd3d,
title = "Association of demographic and socioeconomic characteristics with differences in use of outpatient dermatology services in the United States",
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.",
author = "Raghav Tripathi and Knusel, {Konrad D.} and Ezaldein, {Harib H.} and Jeffrey Scott and Bordeaux, {Jeremy S.}",
year = "2018",
month = "11",
day = "1",
doi = "10.1001/jamadermatol.2018.3114",
language = "English (US)",
volume = "154",
pages = "1286--1291",
journal = "JAMA Dermatology",
issn = "2168-6068",
publisher = "American Medical Association",
number = "11",

}

TY - JOUR

T1 - Association of demographic and socioeconomic characteristics with differences in use of outpatient dermatology services in the United States

AU - Tripathi, Raghav

AU - Knusel, Konrad D.

AU - Ezaldein, Harib H.

AU - Scott, Jeffrey

AU - Bordeaux, Jeremy S.

PY - 2018/11/1

Y1 - 2018/11/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85054127182&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85054127182&partnerID=8YFLogxK

U2 - 10.1001/jamadermatol.2018.3114

DO - 10.1001/jamadermatol.2018.3114

M3 - Article

C2 - 30267073

AN - SCOPUS:85054127182

VL - 154

SP - 1286

EP - 1291

JO - JAMA Dermatology

JF - JAMA Dermatology

SN - 2168-6068

IS - 11

ER -