| Description |
- Objective:
Compare differences in demographics, comorbidities, and ED visits or hospitalizations in Black versus White AIBD patients evaluated and treated at Duke Dermatology between 2012-2021.
Background:
Previous cross-sectional studies of AIBD patients in the US have demonstrated increased rates of hospitalization among certain racial groups1. Studies have also shown racial disparities in therapeutic management in patients with autoimmune disease2,3,4. Differences in clinical outcomes and demographics in AIBD patients remain largely unexplored.
Methods:
Data was retrospectively collected from the electronic medical record for all pemphigus patients seen by Duke Dermatology between 2012 and 2021.
Results:
Our study examined demographic and clinical variables among Black and White patients diagnosed with pemphigus and pemphigoid. For Charlson Comorbidity Index, the distribution among Black pemphigus patients showed 0 (0%), 1-2 (38.7%), and 3+ (61.3%) compared to White pemphigus patients with 0 (0%), 1-2 (17.1%), and 3+ (20.0%). Among pemphigoid patients, the distribution was similar: Black patients had 0 (0%), 1-2 (38.7%), and 3+ (61.3%), while White patients had 0 (0%), 1-2 (42.4%), and 3+ (0%).
Regarding ED visits, Black pemphigus patients experienced a rate of 25.8% compared to 17.1% for White pemphigus patients. Hospital admissions were 30.6% for Black pemphigus patients and 5.7% for White pemphigus patients. In contrast, among pemphigoid patients, ED visits were 25.8% for Black patients and 32.2% for White patients, with hospital admissions at 30.6% and 16.9%, respectively.
For age distribution, Black pemphigus patients were primarily aged 41 and above (80.0%), while White pemphigus patients were 41 and above (94.4%). In contrast, age distribution among pemphigoid patients showed similar trends: Black patients were 41 and above (98.3%), and White patients were 41 and above (98.3%).
Conclusions:
Based on the data from the provided tables, our study reveals notable disparities and trends among Black and White patients diagnosed with pemphigus and pemphigoid. Black patients, both with pemphigus and pemphigoid, exhibit a higher prevalence of severe comorbidities, as indicated by a greater proportion categorized with a Charlson Comorbidity Index score of 3+ compared to their White counterparts.
Regarding healthcare utilization, Black patients with pemphigus show higher rates of emergency department (ED) visits and hospital admissions than White patients. This pattern is also observed among Black pemphigoid patients, who demonstrate elevated rates of ED visits compared to their White counterparts, albeit with varying hospital admission frequencies between the groups.
Limitations of our study include a relatively small sample size and the absence of longitudinal data, which may limit the generalizability of our findings. Future research efforts should focus on exploring how racial, socioeconomic, and geographic factors impact treatment decisions and clinical outcomes among patients with pemphigus and pemphigoid, aiming to address and mitigate observed disparities in healthcare delivery and patient outcomes.
References:
1. Hsu, D. Y., Brieva, J., Sinha, A. A., Langan, S. M., & Silverberg, J. I. (2016). Comorbidities and inpatient mortality for pemphigus in the USA. British Journal of Dermatology, 174(6), 1290-1298.
2. Alchirazi, K. A., Mohammed, A., Eltelbany, A., Albakri, A. A., Alkhayyat, M., Abu-Shawer, O., & Regueiro, M. (2022). S1045 Racial Disparities in Utilization of Medications in Inflammatory Bowel Disease Patients. Official journal of the American College of Gastroenterology| ACG, 117(10S), e758-e759.
3. He, E., Cornblath, E., Yalamanchi, P., Ogdie, A., Baker, J., & George, M. (2020, October). Characterization of Racial Disparities in Rheumatoid Arthritis Treatment Choice and Location of Care. In ARTHRITIS & RHEUMATOLOGY (Vol. 72). 111 RIVER ST, HOBOKEN 07030-5774, NJ USA: WILEY.
4. Hodges, W. T., Bhat, T., Raval, N. S., Herbosa, C., Ugwu‐Dike, P., Kwatra, S. G., ... & Semenov, Y. R. (2021). Biologics utilization for psoriasis is lower in black compared with white patients. British Journal of Dermatology, 185(1), 207-209.
5. Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of chronic diseases, 40(5), 373-383.
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