Language proficiency and biologics access: a population study of psoriasis patients in the United States

Abstract

Background

Language proficiency plays an important role in healthcare choices and access. Differences in access to biologic medications exist, but it is unknown how much English proficiency influences access in US psoriasis patients.

Objective

To compare biologic medication use for psoriasis patients with differing English proficiency levels.

Methods

Population study of US psoriasis patients using the 2013–2017 Medical Expenditure Survey.

Results

Among a total of 4,470,820 US psoriasis patients (weighted), 4,028,119 (90.1%) had perfect English proficiency, and 442,700 (9.9%) had less than perfect English proficiency. Among the total population, 422,523 (9.5%) had access to biologics. Among those who received biologics, 411,411 (97.4%) of those had perfect English proficiency, and 11,112 (2.6%) of those had less than perfect English proficiency. Multivariate logistic regression found that patients with less than perfect English proficiency were significantly less likely to have access to biologics [OR 0.015 (95% CI: 0.001–0.179); p = .002], after adjusting for insurance status, income, education, healthcare utilization, and other sociodemographic and clinical factors.

Limitations

Psoriasis disease severity not specified.

Conclusions

Psoriasis patients with low English proficiency are significantly less likely to receive biologics than those with high English proficiency. Those with higher English proficiency are 61 times more likely to access biologics.

Keywords:

• Psoriasis
• biologics
• communication
• healthcare access
• United States
• English proficiency
• language

Disclosure statement

Dr. Armstrong has served as an investigator and/or consultant to Abbvie, BMS, Dermavant, Dermira, Eli Lilly, Janssen, Leo Pharma, Kyowa Hakko Kirin, Modernizing Medicine, Novartis, Ortho Dermatologics, Regeneron, Sanofi, Sun Pharma, and UCB.

Availability of data statement

The datasets generated during and/or analyzed during the current study are available in the AHRQ RDC repository, https://meps.ahrq.gov/mepsweb/data_stats/onsite_datacenter.jsp