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Barriers to Care Among Sexual and Gender Minority Individuals With Chronic Inflammatory Skin Diseases in the US

Nock, Michael R; Kamal, Kanika; Zampella, John G; Roberson, Mya L; Cohen, Jeffrey M; Barbieri, John S
IMPORTANCE/UNASSIGNED:Research on the prevalence of barriers to care among sexual and gender minority (SGM) patients with chronic inflammatory skin diseases (CISDs) in the US is limited. OBJECTIVE/UNASSIGNED:To compare the prevalence of cost and noncost barriers to care among SGM and non-SGM patients with CISDs and to analyze the prevalence of barriers based on SGM status and race and ethnicity. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:A cross-sectional study of health care access and utilization survey data collected by the National Institutes of Health's All of Us Research Program between May 31, 2017, and July 1, 2022, was conducted. Participants were adults aged 18 years or older with CISDs who enrolled in All of Us directly online or through partner health care practitioner organizations located across the US. EXPOSURES/UNASSIGNED:Chronic inflammatory skin diseases, sexual orientation and gender identity, and race and ethnicity. MAIN OUTCOME AND MEASURES/UNASSIGNED:The main outcome was the experience of cost and noncost barriers to health care among SGM patients with CISDs. Multivariable logistic regression was used to examine the association of SGM status with experiencing barriers to care. RESULTS/UNASSIGNED:This study included 19 743 patients with CISDs; 1877 were SGM patients (median age, 40.5 years [IQR, 28.7-57.9 years]; 1205 [64.2%] assigned female sex at birth) and 17 866 were non-SGM patients (median age, 57.1 years [IQR, 40.8-68.1 years]; 13 205 [73.9%] assigned female sex at birth). Compared with non-SGM patients, SGM patients with CISDs were significantly more likely to delay specialist care (adjusted odds ratio [AOR], 1.23; 95% CI, 1.03-1.47), mental health care (AOR, 1.62; 95% CI, 1.37-1.91), and filling a prescription (AOR, 1.30; 95% CI, 1.11-1.52) because of cost. In addition, SGM patients with CISDs were significantly more likely than non-SGM patients to delay care because of transportation issues (AOR, 1.49; 95% CI, 1.22-1.80) and not having a health care practitioner who shares the same background with regard to race and ethnicity, religion, native language, sexual orientation, and gender identity (AOR, 1.39; 95% CI, 1.19-1.62). Sexual and gender minority patients with CISDs were also significantly more likely than non-SGM patients to report not always being treated with respect by their health care practitioners (AOR, 1.47; 95% CI, 1.30-1.65). CONCLUSIONS AND RELEVANCE/UNASSIGNED:The findings of this cross-sectional study of survey data suggest that SGM patients with CISDs may be disproportionately affected by cost and noncost barriers to health care. Dermatologists and other health care practitioners caring for SGM patients with CISDs have an important role in helping to address these barriers and larger systemic issues for SGM patients at both the patient and system levels.
PMID: 37755822
ISSN: 2168-6084
CID: 5570522

Incidence, survival, and prognostic factors associated with malignant nodular hidradenoma in the United States

Ugwu, Nelson; Cheraghlou, Shayan; Ko, Christine J; Cohen, Jeffrey M
PMID: 36228937
ISSN: 1097-6787
CID: 5361092

Utilization, cost, and prescription patterns of dupilumab among Medicare beneficiaries in the United States from 2017 to 2019

Murphy, Michael J; Cheraghlou, Shayan; Damsky, William; Cohen, Jeffrey M
PMID: 36137225
ISSN: 1471-1753
CID: 5335612

Trends in the Cost and Utilization of Omalizumab in the Medicare Population: 2013-2017

Cheraghlou, Shayan; Ugwu, Nelson; Yu, Beverly; Cohen, Jeffrey M
PMID: 35782473
ISSN: 1551-4056
CID: 5278322

Provider-level prescription patterns among dermatologists utilizing injectable biologics in psoriasis treatment [Letter]

Ugwu, Nelson; Cheraghlou, Shayan; Feng, Hao; Cohen, Jeffrey M
PMID: 35509155
ISSN: 1471-1753
CID: 5216282

The Use of Mycophenolate Mofetil in the Treatment of Bullous Pemphigoid

Liang, Sydney; Cohen, Jeffrey; Soter, Nicholas
BACKGROUND:The first-line treatment for patients with bullous pemphigoid (BP), the most common autoimmune blistering disease, is systemic glucocorticoids, which are associated with numerous side effects. Mycophenolate mofetil (MMF) may be beneficial in BP as a steroid-sparing alternative; however, evidence is limited. OBJECTIVES/OBJECTIVE:To evaluate the efficacy and safety of MMF in patients with BP. METHODS:In this retrospective chart review, records of patients with BP treated with MMF alone or in combination with prednisone, who presented between 2013 and 2017, were analyzed. RESULTS:Twenty-six patients were included. Twelve patients were treated with MMF alone (monotherapy) and fourteen were treated with MMF and prednisone concomitantly at some point during their treatment course (dual therapy). Improvement in BP was observed in 26 (100%) patients with MMF therapy. Mean time to improvement was 0.8 months. Twenty-five (96.2%) patients [11/12 (91.7%) on monotherapy and 14/14 (100%) on dual therapy] achieved complete control of their disease. Mean time to complete control amongst all patients was 5.6 months. Twelve (46.2%) patients [4/12 (33.3%) on monotherapy and 8/14 (57.1%) on dual therapy] experienced disease remission with no subsequent flares for up to 15 months after MMF was discontinued. Twelve mild adverse effects were reported with one individual discontinuing therapy due to gastrointestinal symptoms. No serious adverse effects were reported. CONCLUSION/CONCLUSIONS:MMF is a safe and effective therapy for BP and can yield improvement and complete response in most patients and remission in some. J Drugs Dermatol. 2022;21(2):151-155. doi:10.36849/JDD.6042.
PMID: 35133108
ISSN: 1545-9616
CID: 5522842

Affirmative dialectical behavior therapy skills training with sexual minority veterans

Cohen, Jeffrey M; Norona, Jerika C; Yadavia, James E; Borsari, Brian
Minority stress theory posits that unique stressors create an invalidating environment, which places sexual minority individuals at increased risk for psychiatric morbidity. Sexual minority veterans' experience of minority stressors results in elevated levels of emotion dysregulation, anxiety, depression, and suicidality. Clinical interventions designed to address minority stress and treat emotional dysregulation and related disorders among sexual minority veterans are warranted. Professional guidelines recommend the adaptation of evidence-based treatments to address the unique features of sexual minority and veteran mental health. Dialectical Behavior Therapy (DBT) is a treatment for emotion dysregulation and related problems that addresses an invalidating environment, which is an appropriate framework for sexual minorities. The current research adapts the Emotion Regulation module of DBT Skills Training. This adaptation highlights minority stress as part of the invalidating environment and adds new teaching points to address the unique features of sexual minority mental health to create Affirmative DBT Skills Training. Six sexual minority veterans completed Affirmative DBT Skills Training meeting on a weekly basis for 10 consecutive weeks. Before and after treatment, participants completed measures of emotion regulation, anxiety, and depression as well as assessments of minority stress processes. Affirmative DBT Skills Training was well received in this sample. Results suggest that the intervention was effective in decreasing emotion dysregulation and symptoms of depression. These findings suggest Affirmative DBT Skills Training is a promising treatment, although more research is warranted, particularly given the small sample size and lack of a control group. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
ISSN: 1878-187x
CID: 5438902

Systemic treatment of psoriasis and psoriatic arthritis in the United States: a cross-sectional study [Letter]

Steuer, Alexa B; Wang, Jason F; Feng, Hao; Cohen, Jeffrey M
PMID: 32715842
ISSN: 1471-1753
CID: 4546502

A 68-Year-Old Man on Azathioprine With New Systemic Symptoms and Widespread Skin Eruption

Liang, Sydney E; Cohen, Jeffrey M; Meehan, Shane A; Rothman, Lisa R; Liebman, Tracey N
PMID: 30957155
ISSN: 1537-6591
CID: 3809032

Childbearing and Family Leave Policies for Resident Physicians at Top Training Institutions

Magudia, Kirti; Bick, Alexander; Cohen, Jeffrey; Ng, Thomas S C; Weinstein, Debra; Mangurian, Christina; Jagsi, Reshma
PMID: 30535210
ISSN: 1538-3598
CID: 3577752