According to a new study, the odds of a black or Hispanic patient visiting an outpatient dermatologist are about half that of a white patient with the same skin condition. The study was published in JAMA Dermatology. Patients most likely to receive outpatient dermatologic services in the study were white, educated women. The findings are among several that describe disparities in the use of outpatient dermatology services.

The new study includes nine years of data from 183,054 dermatology patients across the country. Researchers from Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center analyzed the data looking for demographic and socioeconomic patterns associated with the use of dermatologic services.

Dermatologic Care

Patients who were male, uninsured, Midwestern, insured by Medicaid/Medicare, or had a lower income or educational status were least likely to receive outpatient dermatologic care. The odds of a man seeking treatment for a dermatologic condition were about two-thirds that of a woman.

Across all patients, service utilization increased proportionately with education level and income. More services for certain patients meant higher costs: the per capita expenditure for white patients ($210) was approximately three times that of black ($63) or Hispanic ($73) patients.

While other variables might have had an impact, ethnic disparities persisted after the researchers controlled for education level, income, insurance status, and sex. "We were surprised by the magnitude of these differences.

It also did not increase access to specialized care, like dermatology, for many demographics. They hope our findings will encourage hospitals and dermatology clinics to consider their quality improvement measures, designed to increase access to care among their patients.

These could include interventions for minority-specific care, such as having an onsite translator, including a financial counselor in the appointment, or increasing outreach in rural areas. Patients may also benefit from interventions that target specific dermatologic conditions.

Diagnosis For Dermatology

Half of the patients in the new study had a diagnosed dermatologic condition, yet only 36% of diagnosed patients sought care. Most patients diagnosed with a skin condition did not seek care at all during the nine-year study period.

The least likely to seek care were patients diagnosed with chronic skin ulcers. Nine out of ten patients with chronic skin ulcers did not see a dermatologist during the study period. Chronic ulcers are a common complication of diabetes and vascular disease.

Dermatologists can help recognize such ulcers and get patients into proper treatment. Without seeking care, patients may be unaware of the causes of their skin conditions. Patients most likely to seek care in the new study were those diagnosed with non-melanoma skin cancers. 

Skin Disorders

Previous research has shown the importance of visiting a dermatologist for patients with skin conditions. Early and accurate diagnoses can improve outcomes, and stave off deadly cancers. Patients least likely to seek care, whether due to demographics or diagnosis, could be at higher risk for serious skin conditions.

Differences in utilization of outpatient dermatologists may be a key predictor for increased mortality and detriment to quality of life in different groups. By understanding the reasons behind these differences through studies like ours, we can begin to develop population-based, targeted interventions.