Racial disparities in length of hospitalization and systemic medication utilization in patients with psoriasis

The growing evidence of chronic inflammation and sequelae caused by psoriasis indicates the need for systemic treatment, including biologics and conventional treatments like methotrexate. However, unconscious racial bias may lead to discrepancies in systemic medication prescription. Racial identity is also suspected to affect comorbidity and hospitalization rates in patients with psoriasis. This study examines the impact of race on hospitalization duration and systemic medication prescription patterns in patients with psoriasis in the United States in 2020. The 2020 Healthcare Cost and Utilization (HCUP) National Inpatient Sample (NIS) database was used, with inpatient admissions over the age of 17 with an ICD-10-coded psoriasis diagnosis included. Patient demographics and hospital characteristics were compared between "non-white" and "white" patients, with white patients as the reference group. The primary outcome, systemic medication prescription, was evaluated using logistic regression models, producing an odds ratio and corresponding 95% confidence interval (CI). The secondary outcome, length of stay, was evaluated using negative binomial regression models to approximate the incident rate ratio and 95% CI. 1,802,720 patients with psoriasis were included in this study. Hispanic, Asian or Pacific Islander, and Native American patients with psoriasis had significantly lower odds of systemic medication prescription than white patients with psoriasis. All non-white racial identities were found to have significantly longer estimated lengths of stay compared to white patients with psoriasis. Disparities in the medication of choice for psoriasis treatment can lead to increased inpatient burden with longer lengths of stay for non-white patients.