10.5826/dpc.1401a60
text/xml
2160-9381
3522
en
Shari Lipner
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
healthcare utilization
Specialty Utilization Disparities Among Hidradenitis Suppurativa Patients in a Retrospective Analysis of the National Ambulatory Medical Care Survey 2006-2016
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Commentary
2024-01-31
2023-05-09
2024-01-31
2024-02-21
e2024060
Dermatol Pract Concept
Shari Lipner
2024/01/31
10.5826/dpc.1401a60
e2024060
Department of Dermatology, Weill Cornell Medicine, New York, New York, USA
2160-9381
healthcare utilization
en
e2024060
Davis, S. A., Lin, H. C., Balkrishnan, R., & Feldman, S. R. (2015). Hidradenitis Suppurativa Management in the United States: An Analysis of the National Ambulatory Medical Care Survey and MarketScan Medicaid Databases. Skin appendage disorders, 1(2), 65–73. https://doi.org/10.1159/000431037
Specialty Utilization Disparities Among Hidradenitis Suppurativa Patients in a Retrospective Analysis of the National Ambulatory Medical Care Survey 2006-2016
https://dpcj.org/index.php/dpc/article/download/3522/2447
Specialty Utilization Disparities Among Hidradenitis
 Suppurativa Patients in a Retrospective Analysis
 of the National Ambulatory Medical Care Survey
                      2006-2016
                                   Katie Roster1, Ahmad Rajeh2, Shari R. Lipner3


1 New York Medical College, New York, New York, USA
2 University of Missouri-Columbia, School of Medicine, Columbia, Missouri, USA
3 Department of Dermatology, Weill Cornell Medicine, New York, New York, USA



Citation: Roster K, Rajeh A, Lipner SR. Specialty Utilization Disparities Among Hidradenitis Suppurativa Patients in a Retrospective
Analysis of the National Ambulatory Medical Care Survey 2006-2016. Dermatol Pract Concept. 2024;14(1):e2024060. DOI: https://doi
.org/10.5826/dpc.1401a60
Accepted: April 9, 2023; Published: January 2024
Copyright: ©2024 Roster et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: Dr. Lipner has served as a consultant for Hoth Therapeutics, Ortho Dermatologics, Moberg Pharmaceuticals, and
Belle Torus Corporation. There are no conflicts of interest declared for the other authors.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Shari R. Lipner, M.D., Ph.D. Department of Dermatology, Weill Cornell Medicine. Email: shl9032@med.cornell.edu



Hidradenitis suppurativa (HS) is a chronic inflammatory                  chi-squared test were conducted using SPSS. Multinomial
disease, with patients often having delayed diagnosis and                logistic regression analysis examined specialty utilization
significant impact on quality of life [1]. Compared to other             differences between groups.
inflammatory diseases, HS required more emergency depart-                     There were an estimated 2,551,126 outpatient HS vis-
ment visits (7.4% versus 4.2%, P < 0.0001) and admissions                its during the study period (1,777,020 NHW, 774,106
(5.1% versus 2.5%, P < 0.0001), according to a medical                   SoC). On average, SoC versus NHW patients were younger
claims database study 2008-2012. In a United States (US)                 (33.6 years versus 37.9, P = 0.015) and had more previous
retrospective analysis of 47,690 HS patients, Blacks were                visits (5.25 versus 3.99, P = 0.020). On chi-squared anal-
three times more likely to be diagnosed with HS compared to              ysis, NHW patients were more often seen by dermatology
Whites [3]. Therefore, we aimed to investigate healthcare uti-           (33.6%) versus family medicine (27.0%) or general surgery
lization among US Non-Hispanic Whites (NHW) and skin of                  (18.7%), while SoC HS patients were more frequently seen
color (SoC) HS patients.                                                 by general surgery (35.9%) or family medicine (34.2%) ver-
    The National Ambulatory Medical Care Survey (NAMCS)                  sus dermatology (10.7%) (P = 0.006, all) (Table 1). Using
2006-2016 was queried for HS visits. Non-Hispanic Black,                 multinomial logistic regression, NHW versus SoC patients
Hispanic, Asian, and Pacific Islander patients were grouped              were more often seen by dermatology, after adjusting for in-
as SoC. Specialty utilization, insurance status, appointment             surance type (OR: 3.288, 95% CI:1.324-8.167, P = 0.010).
wait time, number of previous visits, visit time, and ap-                There were no statistically significant differences for sex,
pointment location were analyzed. Analysis of variance and               ­insurance type, appointment wait time, visit time, or location.



Commentary | Dermatol Pract Concept. 2024;14(1):e2024060                                                                               1
                        Table 1. Differences in Non-Hispanic Whites NHW skin of color
                                   and SoC hidradenitis suppurativa patients.
                                                                      NHW
                                                                  N = 1,777,020                SoCN = 774,106             P-value
 Age (SE)                                                           37.91 (0.94)                 33.59 (1.48)              0.015
 Sex, N (%)                                                                                                                0.065
    Male                                                          563,880 (31.7)                121,455 (15.7)
    Female                                                       1,213,140 (68.3)               652,651 (84.3)
 Specialty, N (%)                                                                                                          0.006
    Dermatology                                                   596,488 (33.6)                 82,797 (10.7)
    General Surgery                                               332,290 (18.7)                277,788 (35.9)
    Family Medicine                                               478,955 (27.0)                264,447 (34.2)
    Other                                                         369,288 (20.9)                149,074 (19.2)
 Time until appointment, N (%)                                                                                             0.056
    <1 week                                                       394,819 (22.2)                173,700 (22.4)
    1-2 weeks                                                     288,242 (16.2)                 243,986 (31.5)
    >2 weeks                                                      62,4911 (35.2)                138,229 (17.9)
    Unknown                                                       469,049 (26.4)                218,192 (28.1)
 Insurance status, N (%)                                                                                                   0.477
    Private                                                      1,024,173 (57.6)               470,576 (60.7)
    Medicaid or Medicare                                          653,592 (36.8)                249,401 (32.2)
    Self-pay                                                        54,915 (3.1)                 50,012 (6.5)
    Unknown                                                         44,340 (2.5)                  4,118 (0.5)
 Number of previous visits, mean (SE)                               3.99 (0.35)                   5.25 (0.34)              0.020
 Appointment time, mean (SE)                                        19.19 (0.92)                  20.91 (1.2)              0.239
 Location, N (%)                                                                                                           0.987
    Metropolitan                                                 1,652,282 (93.0)               720,540 (93.1)
    Non-metropolitan                                               124,739 (7.0)                 53,567 (6.9)

NHW = Non-Hispanic White; SoC = skin of color (Asian or Pacific Islander, non-Hispanic Black, and Hispanic); SE = standard error.
Tables (NHW) and (SoC) HS patients.


    We identified significant healthcare specialty utilization       (28% versus 2%) [5]. Therefore, limited dermatologist access
disparities between NHW and SoC HS patients, validating a            might contribute to non-evidenced based HS management,
single institution retrospective analysis of 2,213 HS patients       particularly among SoC patients, which could explain their
2017-2020, reporting that Blacks versus Whites were treated          having more frequent appointments and being treated surgi-
less often by dermatology or primary care, and more often            cally rather than medically.
by surgery for HS-related visits.                                        Non-NHW patients were designated as SoC, limiting
    A cross-sectional commercial database study 2007-2017            differentiation among racial/ethnic groups. Socioeconomic
reported that dermatologists versus non-dermatologists pre-          status and education level, which influence healthcare utili-
scribed opiates less often (OR: 0.23, 95% CI: 0.17-0.31)             zation, were not studied.
and prescribed nonantibiotic systemic medications more fre-              In sum, we identified significant healthcare specialty
quently (OR: 6.44, 95% CI: 4.87-8.52) to HS patients [4].            utilization disparities between NHW and SoC HS patients,
In a retrospective NAMCS analysis 1990-2009, dermatolo-              with NHW patients more likely to be seen by dermatologists
gists managed HS patients with a combination of procedure            and requiring fewer visits. These findings underscore the im-
and medications more often than versus non-dermatologists            portance of addressing dermatologic care barriers, particu-
(15% versus 6%), while non-dermatologists were more likely           larly for SoC HS patients, to optimize disease management
to provide neither medication nor procedural treatments              and reduce the need for surgical intervention.




2                                                                           Commentary | Dermatol Pract Concept. 2024;14(1):e2024060
References                                                              4. Wehner MR, Micheletti R, Noe MH, Linos E, Margolis DJ,
                                                                           Naik HB. Hidradenitis suppurativa encounters in a national
 1. Udechukwu NS, Fleischer AB Jr. Higher Risk of Care for Hidra-          electronic health record database notable for low dermatology
    denitis Suppurativa in African American and Non-Hispanic Pa-           utilization, infrequent biologic prescriptions, and frequent opi-
    tients in the United States. J Natl Med Assoc. 2017;109(1):44-48.      ate prescriptions. J Am Acad Dermatol. 2020;82(5):1239-1241.
    DOI: 10.1016/j.jnma.2016.09.002. PMID: 28259215.                       DOI: 10.1016/j.jaad.2019.12.030. PMID: 31866261; PMCID:
 2. Khalsa A, Liu G, Kirby JS. Increased utilization of emergency          PMC6980686.
    department and inpatient care by patients with hidradenitis         5. Davis SA, Lin HC, Balkrishnan R, Feldman SR. Hidradeni-
    suppurativa. J Am Acad Dermatol. 2015;73(4):609-614. DOI:              tis Suppurativa Management in the United States: An Analysis
    10.1016/j.jaad.2015.06.053. PMID: 26190241.                            of the National Ambulatory Medical Care Survey and Market
 3. Robinson I, Lee L, Cotton C. The Impact of Racial Differences          Scan Medicaid Databases. Skin Appendage Disord. 2015;1(2):
    on Treatment Strategies in Hidradenitis Suppurativa: A Retro-          65-73. DOI: 10.1159/000431037. PMID: 27172455. PMCID:
    spective Review. J Drugs Dermatol. 2022;21(3):270-275. DOI:            PMC4857854.
    10.36849/JDD.6446. PMID: 35254766.




Commentary | Dermatol Pract Concept. 2024;14(1):e2024060                                                                                  3
