Acta Dermato-Venereologica Issue No. 97-5 97-5CompleteContent | Page 19

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CLINICAL REPORT
Socioeconomic Inequalities and Severity of Plaque Psoriasis at a
First Consultation in Dermatology Centers
Emmanuel MAHÉ 1 , Alain BEAUCHET 2 , Ziad REGUIAI 3 , François MACCARI 4 , Mireille RUER-MULARD 5 , Guillaume CHABY 6 ,
Thierry LE GUYADEC 7 , Eric ESTÈVE 8 , Catherine GOUJON-HENRY 9 , Josiane PARIER 10 , Hugues BARTHELEMY 11 , Edouard
BÉGON 12 , Henri-Georges STEINER 13 , Nathalie BÉNÉTON 14 , Thierry BOYÉ 15 , Laure MERY-BOSSARD 16 , Jean-Luc SCHMUTZ 17 ,
Pierre BRAVARD 18 , Michèle-Léa SIGAL 1 and the GEM RESOPSO
Department of Dermatology, Hôpital Victor Dupouy, Argenteuil, 2 Department of Public Health, Centre Hospitalier Universitaire Ambroise Paré,
University of Versailles-Saint-Quentin-en-Yvelines, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, 3 Department of Dermatology,
Hôpital Robert Debré, Reims, 4 Department of Dermatology, Hôpital d’Instruction des Armées Bégin, Saint-Mandé, 5 Private Office, Martigues,
6
Department of Dermatology, Hôpital Sud, Centre Hospitalier Universitaire d’Amiens, Picardie-Jules Verne University, Amiens, 7 Department of
Dermatology, Hôpital d’Instruction des Armées Percy, Clamart, 8 Department of Dermatology, Centre Hospitalier Régional d’Orléans, Orléans,
9
Department of Clinical Immunology and Allergy, Centre Hospitalier Lyon-Sud, Lyon, 10 Private Office, Paris, 11 Department of Dermatology,
Centre Hospitalier d’Auxerre, Auxerre, 12 Department of Dermatology, Centre Hospitalier de Pontoise, Pontoise, 13 Private Office, Vienne,
14
Department of Dermatology, Centre Hospitalier du Mans, Le Mans, 15 Department of Dermatology, Hôpital d’Instruction des Armées Sainte
Anne, Toulon, 16 Department of Dermatology, Hôpital François Quesnay, Mantes-La-Jolie, 17 Department of Dermatology, Hôpital Brabois,
Vandœuvre-Les-Nancy, and 18 Department of Dermatology, Hôpital Jacques Monod, Le Havre, France
1
Psoriasis has major physical, psychological, and social
impacts: its management should not be restricted by
individual financial considerations in Western countri-
es as these have well-structured health systems and
social/insurance coverage. We investigated if the so-
cioeconomic characteristics of patients were associa-
ted with severity of psoriasis and access to healthcare.
In a cross-sectional study, we included 903 patients
with psoriasis that were consulting for the first time.
We showed that low educational level was associated
with severity of disease in multivariate analyses. Mo-
reover, patients of lower class and lower educational
level, with severe psoriasis, had seen fewer physicians
and had less frequently received a systemic treatment.
Thus, physicians need to be vigilant e of patients with
a low socioeconomic status. Both low socioeconomic
status and less access to dermatologists are associa-
ted with clinical severity of psoriasis at a first consul-
tation.
Key words: psoriasis; social inequalities; treatment; epidemio-
logy.
Accepted Jan 25, 2017; Epub ahead of print Jan 27, 2017
Acta Derm Venereol 2017; 97: 632–638.
Corr: Emmanuel Mahe, Department of Dermatology, Hôpital Victor Du-
pouy, FR-95100 Argenteuil, France. E-mail: emmanuel.mahe@ch-argen-
teuil.fr
P
soriasis is a chronic skin and articular disease that
affects 2–4% of the population (1, 2). It is known to
have major physical, psychological, and social impacts
(2–4). Recently physical (i.e., cardiovascular, metabolic)
and psychological (i.e., depression) comorbidities have
been associated with psoriasis (5–8).
Topical and systemic treatments can improve clinical
aspects, quality of life (QoL), and social discomfort. It
has been suggested that the use of systemic treatments
for severe forms of psoriasis could reduce the cardio-
vascular risk linked with psoriasis-associated chronic
inflammation (9–14). Thus, adequate management and
doi: 10.2340/00015555-2625
Acta Derm Venereol 2017; 97: 632–638
adherence to treatments are important. The management
of psoriasis should not be restricted by individual finan-
cial considerations in most Western countries, which
have well-structured health systems and offer social or
insurance coverage.
Socioeconomic and demographic inequalities are ma-
jor determinants of health status (15, 16). These differ
from one country to another, but also within countries.
Infectious diseases are probably the diseases most im-
pacted by these inequalities because, for instance, of
sanitary factors caused by socioeconomic inequalities.
More recently, it has been shown that the stage of can-
cers is more advanced at diagnosis in populations with
a low socioeconomic status (17, 18). This is also true
for chronic cardiovascular and metabolic diseases, and
for acute events, such as stroke or myocardial infarction
(19–21). The consequences can be tremendous for the
patient as the prognoses of these diseases depend on their
early diagnosis.
Despite the high frequency of psoriasis, few and dis-
cordant data are evaluable on its link with socioeconomic
and demographic status, on adherence to medication,
severity of the disease, or access to treatments (22–25).
Thus, we have investigated if the socioeconomic and
demographic characteristics of patients consulting for the
first time with psoriasis are associated with its severity
and access to healthcare.
MATERIALS AND METHODS
The “R-ens” study (“Resopso - Evaluation Nationale du parcours
de Soins pour un psoriasis”) was a non-interventional, cross-
sectional, multicenter study that included adults with psoriasis.
R-ens was designed to evaluate the impact of the socioeconomic
and demographic characteristics of the patients with the severity
of psoriasis at a first consultation.
Investigative centers
R-ens was performed in 40 French dermatology centers, which
were all members of the GEM Resopso between January and No-
This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta
Journal Compilation © 2017 Acta Dermato-Venereologica.