Socioeconomic differences in treatment for immunobullous disorders: An all of us analysis

Summary: Abstract Body: Socioeconomic disparities in healthcare have been well-documented across various medical conditions, yet their impact on the management of autoimmune blistering dermatoses remains underexplored. These rare, chronic diseases require complex, long-term therapies, making them particularly susceptible to disparities influenced by social and economic factors. This study aims to address this gap through an analysis of the NIH All of Us Research Program evaluating prescription trends in patients with autoimmune bullous dermatoses, focusing on socioeconomic factors. Multiple multivariate regression models were made assessing various therapeutic treatments (cyclophosphamide, azathioprine [AZA], mycophenolate mofetil [MMF], rituximab, and corticosteroids) with socioeconomic covariates such as race, gender, age, and annual income. The Benjamini-Hochberg correction was used for multiple comparisons. Out of 287,012 patients included in the database, there were 256 patients identified to have an autoimmune bullous dermatosis. Of these patients, the mean age was 70.4 (SD, 14.6) years, and 56.6% were female, 3.9% identified as neither male nor female, 65.2% identified as White, 10.5% identified as Black or African American, 6.3% identified as Asian, and 18.0% identified as another race. After adjusting for covariates, there were no socioeconomic differences in corticosteroid, cyclophosphamide, or rituximab usage. However, individuals in the Asian cohort were more likely to have been prescribed AZA (OR=7.50, p=0.009, 95% CI=1.64-34.24) and MMF (OR=3.92, p=0.038, 95% CI=1.08-14.20). Individuals in the Other Race cohort were more likely to have been prescribed MMF (OR=3.03, p=0.009, 95% CI=1.32-6.93). These findings highlight the potential impact of social and economic factors on treatment disparities in autoimmune blistering dermatoses, especially in the treatment of minority populations and genders. Future research should explore whether these disparities reflect differences in management or influence patient outcomes. Christopher Guirguis¹, Lauren Ching¹, Thomas K. Le¹, Timothy Patton¹, Joe Tung¹ 1. Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States. Minoritized Populations and Health Disparities Research