Racial and ethnic differences in barriers to care among US adults with chronic inflammatory skin diseases: A cross-sectional study of the All of Us Research Program

Abstract

Background: Research on racial and ethnic differences in barriers to care among patients with chronic inflammatory skin diseases (CISDs) is limited.

Objective: To investigate the prevalence of a broad range of barriers to care among patients with CISDs across different racial and ethnic groups.

Methods: A cross-sectional study was conducted using survey data from participants with CISDs in the All of Us Research Program. Multivariable regression was used to analyze the relationship between race and ethnicity and experiencing barriers to care.

Results: Our study included 16,986 patients with CISDs. Compared to White patients, Black and Hispanic patients were significantly more likely to delay care because of cost and a broad range of additional structural barriers, including transportation, work, childcare, adult care, living in a rural area, and the lack of health care workforce diversity. However, associations between race and ethnicity and many barriers to care were substantially attenuated after controlling for insurance, income, and education.

Limitations: The population studied was not a representative sample of US adults, and responses were not specific to dermatologic care.

Conclusion: Racial and ethnic minority patients with CISDs, especially Black and Hispanic patients, are disproportionately affected by a broad range of barriers to care.

Keywords: access; acne; affordability; atopic dermatitis; barriers to care; chronic inflammatory skin diseases; cost; disparities; diversity; psoriasis; racial and ethnic differences; racial and ethnic minorities; rural; transportation.