Racial and ethnic disparities in atopic dermatitis medication utilization

Summary: Abstract Body: Atopic dermatitis (AD) is an inflammatory skin condition with increasing treatment options, but disparities in its management remain understudied. We examined disparities in the utilization of treatments for AD, specifically dupilumab, crisaborole, topical JAK inhibitors (TJAKIs), and topical calcineurin inhibitors (TCIs). An analysis was conducted using aggregated data from Epic Cosmos, representing over 289 million patient records from over 1600 hospitals and 37,700 clinics. We included patients with an AD diagnosis (ICD-10 L20.*) between 1/1/2021 and 12/31/2023, who received care in the U.S. and had age documented at the encounter. Patients were divided by race, ethnicity, legal sex, and census region. Utilization rates for each treatment were calculated. We identified 1,660,680 AD patients and disparities were observed. Overall, black patients had the lowest rates of each treatment: dupilumab (Asian: 4.8%, Black: 3.9%, Other: 4.0%, White: 4.6%); crisaborole (Asian: 3.9%, Black: 3.6%, Other: 3.4%, White: 3.3%); TJAKIs (Asian: 1.1%, Black: 0.4%, Other: 0.7%, White: 0.8%); and TCIs (Asian: 13.2%, Black: 9.2%, Other: 9.9%, White: 9.6%). Similarly, Hispanic patients had lower rates compared to non-Hispanics (dupilumab: 2.3% vs. 4.7%; crisaborole: 3.1% vs. 3.3%; TJAKIs: 0.4% vs. 0.8%; TCIs: 7.1% vs. 10.1%). Females had higher rates than males (dupilumab: 4.3% vs. 4.1%; crisaborole: 3.4% vs. 3.2%; TJAKIs: 0.9% vs. 0.5%; TCIs: 10.6% vs. 8.2%). Regional differences varied depending on the treatment. For dupilumab and TCIs, the Northeast had the highest rates (dupilumab: 5.5%, TCIs: 12.2%). The rates for TJAKIs were higher in the Northeast and West (both 1.0%) compared to the South (0.6%) or Midwest (0.5%). The rate for crisaborole was highest in the South (5.1%). Limitations include potential classification bias and patients selecting multiple races. These findings suggest significant disparities in AD treatment across demographic groups. Further investigation is needed to identify underlying factors and inform interventions to ensure equitable access to AD therapies. Mihir M. Shah¹, Gordon H. Bae² 1. Stanford University School of Medicine, Stanford, CA, United States. 2. Dermatology, Stanford Medicine, Stanford, CA, United States. Minoritized Populations and Health Disparities Research