Sociodemographic disparities in patch testing for commercially insured dermatitis patients: a retrospective analysis of administrative claims data.

To the Editor: Contact dermatitis (CD) is a common dermatologic disorder, and management relies on avoiding the offending agent. Chronic CD has been associated with profound psychosocial and economic impacts.1Kadyk D.L. Hall S. Belsito D.V. Quality of life of patients with allergic contact dermatitis: an exploratory analysis by gender, ethnicity, age, and occupation.Dermatitis. 2004; 15: 117-124Crossref PubMed Scopus (28) Google Scholar Patch testing (PT) remains the gold standard in diagnosing allergic contact dermatitis (ACD), and a higher number of allergens tested is associated with greater diagnostic sensitivity2Cheraghlou S. Watsky K.L. Cohen J.M. Utilization, cost, and provider trends in patch testing among Medicare beneficiaries in the United States from 2012 to 2017.J Am Acad Dermatol. 2021; 85: 1218-1226Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar; thus, barriers to PT can delay diagnosis and management, increasing the burden of disease. In this study, we used a large US claims database to evaluate for sociodemographic disparities in access to PT. We characterized PT utilization in CD patients from January 2016 to June 2020, using Clinformatics Data Mart, a deidentified database of administrative health claims for patients from all 50 states. Study cohorts were identified by the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes L23 (ACD), L25 (CD, unspecified), L30.9 (dermatitis, unspecified), and R21 (rash and other nonspecific skin eruption); patient continuous enrollment was required from 2016 to 2019. The primary outcome was PT utilization (Current Procedural Terminology code 95044: patch or application test[s] [specify the number of tests]). The number of allergens tested was determined by cumulative associated service counts when available (0-300 per date of service). Within each ICD-10-CM code, the percent of patients who underwent PT and the number of allergens tested per patient were assessed for each sociodemographic group. In total, 1,107,530 patients were identified, with the majority being female (59%) and White (69%). Significantly lower rates of PT were observed in patients of less education, lower income, Black race, male gender, and age 0-12 years (Table I). These findings held true whether evaluating patients diagnosed with ACD, CD, dermatitis, or rash. Patients of less education, lower income, Black race, and age 0-12 years also had fewer allergens tested (Table II).Table IPercent of patients from each sociodemographic group that underwent patch testing from 2016 to 2020, for each diagnosis codeAllergic CD (L23)CD, unspecified (L25)Dermatitis (L30.9)Rash (R21)(N = 179,842)(N = 175,256)(N = 472,484)(N = 553,757)TotalPT, n (%)TotalPT, n (%)TotalPT, n (%)TotalPT, n (%)Gender Female109,5568058 (7.4)102,3674431 (4.3)277,2616407 (2.3)331,1055615 (1.7) Male70,2862906 (4.1)72,8891632 (2.2)195,2232722 (1.4)222,6522249 (1.0)Education <12th Grade57821 (3.6)73514 (1.9)189014 (0.7)225617 (0.8) HS diploma37,7111700 (4.5)40,3331001 (2.5)92,5951417 (1.5)120,4591298 (1.1) 更多