Evaluating the psychosocial burden and unmet needs for health care access among older adults with inflammatory skin disease.

To the Editor: Inflammatory skin disease (ISD) is prevalent among older adults,1 but there are minimal data on the psychosocial burden of ISD and health care access among this population. Focused study on these areas in older adults is crucial given the growing aging population and their unique characteristics.
We performed a cross-sectional analysis of data from the Health and Retirement Study (HRS), an ongoing, nationally representative survey of US adults over age 50, to explore the psychosocial burden of ISD and identify unmet needs for health care access among older adults. In 2019, the HRS included questions specifically about ISD, and the supplementary questionnaire had an 83% response rate. Our final sample included 4774 respondents that completed all study components.
ISD was defined as a self-reported physician diagnosis of psoriasis, atopic dermatitis, alopecia areata, and/or vitiligo. These conditions were selected based on the data available through the HRS. Psychosocial burden was recorded through individual measures of life satisfaction, subjective well-being, participation in activities, and isolation. Component scores were aligned so that higher values indicated less psychosocial burden. These scores were converted to standardized z-scores (mean = 0; SD = 1), which were averaged to obtain a composite score. Linear regression models were used to examine relationships between psychosocial scores, respondent characteristics, and ISD. Barriers to care were identified through self-reported trouble finding a specialist. Logistic regression models were used to examine the association between trouble finding a dermatologist and ISD. To allow for comparison with other systemic inflammatory conditions in the HRS, respondents with inflammatory bowel disease (IBD) and rheumatoid arthritis (RA) were also analyzed.
ISDs were reported in 12.6% of respondents and were more common among females than males (OR = 1.58, 95% CI = 1.26-1.99) and less common in Black than White respondents (OR = 0.67, 95% CI = 0.50-0.89). ISDs as a group were significantly associated with worsened isolation prior to adjustment via the Holm-Bonferroni method (beta = −0.101, P = .046, adjusted P = .230). None of the individual ISDs were significantly associated with composite psychosocial outcome (Table I). IBD (beta = 0.117, P = .508) and RA (beta = −0.089, P = .071) also lacked significant disease associations with composite psychosocial score. ISD respondents were more likely to report trouble finding a dermatologist (adjusted OR [aOR] = 2.54, 95% CI = 1.15-5.26), although the absolute proportion was low (1.83%). For comparison, IBD and RA respondents did not report significant trouble finding a gastroenterologist (aOR = 1.25, 95% CI = 0.20-4.39) or rheumatologist (aOR = 1.41, 95% CI = 0.58-3.15), respectively. Of the ISD respondents who endorsed difficulty when seeking a specialist, 34.4% reported delaying care due to cost (Fig 1). When asked what non-cost-related difficulty was encountered when seeking a specialist, 30.6% cited a lack of appointments.