P32 The association between socioeconomic deprivation and severity of psoriasis at point of access to first biologic treatment: a cross-sectional study from the British Association of Dermatologists Biologics and Immunomodulators Register
Journal: British Journal of Dermatology (2024)

Abstract Socioeconomic deprivation is associated with poorer health outcomes. Biologic therapies have transformed treatment for moderate-to-severe psoriasis, improving quality of life. Research on the association between socioeconomic deprivation and access to care for psoriasis is limited, particularly in the United Kingdom, and represents an important gap in the evidence. Our objective was to investigate whether socioeconomic deprivation is associated with psoriasis severity at the point of access to first biologic treatments. We conducted a cross-sectional study using the British Association of Dermatologists Biologic Interventions Register (BADBIR), a national pharmacovigilance register in the UK and Eire, including biologic-naïve psoriasis patients from November 2007 to April 2024. Socioeconomic deprivation was proxied using the Index of Multiple Deprivation (IMD), categorized into 20% most deprived, middle 40% and 40% least deprived. The outcome measure was psoriasis area and severity index (PASI) at baseline. We performed descriptive analyses, as well as crude and adjusted multivariable regression analyses with IMD as the exposure and PASI at biologic initiation as the primary outcome, adjusting for demographic and individual factors such as age, sex, disease duration, conventional treatment duration and clinical characteristics including body mass index and psoriatic arthritis status. Our secondary outcome was the association between dermatology life quality index (DLQI) and IMD. We also conducted a stratified analysis for ethnicity (white, black, Asian and other). A total of 5353 patients [41.2% female, 88.8% white ethnicity, median age 44 interquartile range (IQR) 34–54] met the inclusion criteria, with 1241(23.2%), 2273(42.5%), and 1839(34.4%) in the most, middle, and least deprived groups, respectively. There were no meaningful differences in characteristics between the groups. The mean PASI at biologic initiation was 15.0 (standard deviation, 7.7), and the most common first biologic was adalimumab (47.6%). In the adjusted regression analysis, with IMD Group 3 (least deprived) as the reference group, patients in IMD Group 2 (middle) had a statistically significant lower PASI (PASI difference −0.7, 95% confidence interval −1.2, −0.2). There was no significant difference in PASI for patients in IMD Group 1 (most deprived) compared with the least deprived. Whilst Group 2 demonstrated statistical significance, the absolute difference in PASI was small. There was no association between DLQI at baseline and IMD group. Our stratified analysis of the data based on ethnicity found no difference from our main analysis. We found no clinically significant association between socioeconomic deprivation and psoriasis severity at biologic initiation as measured by PASI. Further research into socioeconomic deprivation and treatment outcomes in psoriasis patients on biologics is needed to understand whether there are any health inequities.