Are Psoriasis and Psoriatic Arthritis Underdiagnosed in Underserved Groups?

Lorraine L. Janeczko, MPH

August 11, 2022

Patients with psoriasis and psoriatic arthritis who belong to underserved groups may not be getting the healthcare they need because of lack of access, a study based on national registry data suggests.

Megan Tran

"Using the All of Us dataset, we identified lower rates of psoriasis and psoriatic arthritis in participants with skin of color, lower education levels, and no health insurance," lead author Megan M. Tran said in her oral presentation at the Society for Investigative Dermatology (SID) 2022 Annual Meeting.

"This suggests psoriasis and psoriatic arthritis underdiagnosis in these underserved populations, possibly due to limited dermatologic care access," added Tran, a second-year medical student at the Warren Alpert Medical School of Brown University in Providence, Rhode Island.

Tran and colleagues used the ongoing National Institutes of Health All of Us Research Program registry that contains a large proportion of participants from groups in the United States who have historically been underrepresented in biomedical research, she said in her talk. 

Of the 329,038 participants with data in version 5 (released this past March) of the All of Us database, 150,158 (45.6%) had skin of color, and 251,597 (76.5%) had available electronic health records (EHRs).

Underserved Groups Need Better Access to Healthcare

Linking data from EHRs, surveys, and physical measurements at enrollment, the researchers used several variables to estimate psoriasis and psoriatic arthritis (PsA) prevalence, and they used multivariate logistic regression to adjust for the variables. They found:

  • 22% of patients with psoriasis had psoriatic arthritis. Odds of psoriasis and psoriatic arthritis were lower among Black (psoriasis OR, 0.32, 95% CI, 0.28 - 0.36; PsA OR, 0.20, 95% CI 0.15 - 0.26) and Hispanic participants (psoriasis OR, 0.77, 95% CI, 0.71 - 0.84; PsA OR, 0.74, 95% CI, 0.61- 0.89) compared with White participants.

  • Psoriasis prevalence increased linearly with age (topping off at age 70 and older [OR, 3.35, 95% CI, 2.91 - 3.88], with 18-29 years as the reference). The same trend was found with PsA (70 years and above [OR, 4.41, 95% CI, 3.07 - 6.55] compared with those aged 18-29 years).  

  • Psoriasis prevalence increased linearly with body mass index (BMI 40 and above [OR, 1.71, 95% CI, 1.54 - 1.90], with 20-24.9 as the reference). The same trend was found with PsA (BMI 40 and above [OR, 2.09, 95% CI, 1.68 - 2.59], with 20-24.9 as the reference).  

  • Former smokers were at increased risk for disease, compared with people who had never smoked (psoriasis OR, 1.30, 95% CI, 1.22 - 1.39; PsA OR, 2.15, 95% CI, 1.33 - 3.78).

  • Lower odds were found in uninsured adults (psoriasis OR, 0.43, 95% CI, 0.35 - 0.52; PsA OR, 0.37, 95% CI, 0.22 - 0.58) compared with those who were insured, and in those with less than a high school degree (psoriasis OR, 0.72, 95% CI, 0.63 - 0.82; PsA OR, 0.65, 95% CI, 0.47 - 0.87) compared with those with a college degree.

"The All of Us research program has demonstrated to be a valuable resource to gain unique dermatologic insights on diverse participant populations," Tran said.

"There needs to be improvement in access to quality dermatologic care, as this may help to reduce underdiagnosis of psoriasis and psoriatic arthritis," she added. Access can be increased  in various ways, including "outreach to underserved communities, equitable distribution of resources, and increased awareness of clinical variations in skin of color."

Laura Korb Ferris, MD, PhD, a professor of dermatology specializing in psoriasis, and the director of clinical trials for the Department of Dermatology of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, finds this study interesting.

Dr Laura Korb Ferris

"Because All of Us uses electronic health records to identify cases, while these findings could suggest that these patients are less likely to develop psoriasis and psoriatic arthritis, it more likely shows that they are less likely to receive care for these conditions," she told Medscape Medical News.

"This is concerning, as psoriasis is associated with other comorbidities such as cardiovascular disease and depression, and psoriatic arthritis if left untreated can cause irreversible joint damage that limits function," she explained in an email. "Both conditions profoundly impact a patient's quality of life.

"It is important to know whether the diagnoses are simply being missed in these patients or are being neglected," noted Ferris, who was not involved in the study. "It is also important to find strategies to improve diagnosis and treatment, improve quality of life, and allow for interventions to improve long-term sequelae of these diseases and their comorbid conditions."

The NIH All of Us Research Program, which aims to build a diverse database from at least 1 million adult participants in the United States as a part of the agency's precision medicine initiative, is open to researchers and to the public. Researchers can access All of Us data and tools to conduct studies at the All of Us Research Hub, and adults who live in the US can contribute their health data at the All of Us Research Program website and at participating healthcare provider organizations.

Tran, study co-authors, and Ferris report no relevant relationships. The All of Us Research Program is supported by the National Institutes of Health.

Society for Investigative Dermatology (SID) 2022 Annual Meeting: Poster 691. Virtual presentation June 13 through August 14, 2022.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.

processing....