422 Healthcare disparities in atopic dermatitis: insights from TARGET-DERM registry
Authors: Lee Lara Wine , Knapp Keith , Munoz Breda , Perez Anthony , Obi Chibuzo , Calimlim Brian , Grada Ayman , Silverberg Jonathan I 
Published: June 2023

Abstract
Atopic dermatitis disproportionately affects diverse patient populations. Furthermore, complex factors may influence the burden of disease and access to treatment amongst different racial and ethnic groups. The aim of this study is to evaluate health disparities and real-world management patterns in distinct populations treated for AD in routine clinical practice. The study included patients with AD (≥age 6) enrolled in TARGET-DERM, an observational, longitudinal study of over 2500 participants across 43 US academic/community centers. Participants were classified in four race/ethnicity categories as reported in enrollment forms and/or patient self-reported: non-Hispanic (NH) White, Black, Asian/Pacific Islander (API) and Hispanic. Patient characteristics analysed included demographics, clinical characteristics, investigator-assessed and patient-reported outcomes, and treatment history. A total of 1928 patients (mean age 34 years; 58% female; 60% enrolled at community-based centers) were included, encompassing 251 NH-Black (13%), 271 NH-API (14%), 288 Hispanic (15%) and 1118 NH-White (58%) participants. Most (71%) had a medical comorbid condition with 30% having ≥3 conditions. Private insurance was highest among NH-APIs (82%) and NH-Whites (70%), Medicaid was highest among Hispanics (46%) and NH-Blacks (27%), and uninsured was highest among NH-Blacks (18%) and NH-Whites (12%). At enrollment, clinical disease severity assessments [vIGA-AD, TBSA and vIGA-ADxTBSA (VxT)] varied by race/ethnicity, also suggesting healthcare disparities. Lowest severity was among NH-Whites (25.9% vIGA-AD clear/almost clear, 26.7% VxT clear/almost clear and median TBSA 5%), followed by Hispanics (21.7%, 18.2% and 7%), NH-Blacks (15.7%, 15.3% and 10%), and NH-APIs (10.7%, 13.8% and 8%). No differences were identified in the distribution of traditional systemic therapies across groups. However, in multivariable analysis (adjusted for age, sex, insurance status, comorbidities, vIGA and treatment status), NH-Blacks and Hispanics were less likely to be treated with advanced systemic therapies than NH-Whites [odds ratio (OR) of 0.67 and 0.70, respectively; P &lt; 0.01]. Similarly, NH-APIs were more likely to have higher vIGA-AD scores than NH-Whites (OR = 1.57; P &lt; 0.01). Non-Hispanic Blacks also had higher vIGA-AD scores than NH-Whites (OR = 1.42; P &lt; 0.05) when controlling for all covariates other than treatment type (P &lt; 0.05), adjustment for which renders the estimated black–white disparity nonsignificant. (OR = 1.32, P = 0.11). Descriptively comparing patient-reported outcome distributions identified no significant differences (P &gt; 0.12). Despite presenting with more severe disease, Blacks and Hispanics have significantly lower odds of using advanced systemic therapy relative to NH-Whites, suggestive of an access disparity leading to disparities in disease control. These disadvantages persist after adjusting for an array of demographic, socioeconomic and medical history characteristics. The results highlight real-world evidence of racial and ethnic disparities among patients with AD.