title: Lower Socioeconomic Status is Associated With Decreased Therapeutic Response to the Biologic Agents in Psoriasis Patients.
abstract: BACKGROUND
  Lower socioeconomic status is associated with poorer overall health outcomes. However, few studies have examined the impact of socioeconomic status on psoriasis.
  
  
  OBJECTIVE
  To examine the impact of individual socioeconomic status on systemic therapeutic outcomes amongst psoriasis patients.
  
  
  METHODS
  The study analyzed 156 psoriasis patients treated at the Tufts Medical Center Department of Dermatology from 2008-2014. Individual socioeconomic status was inferred from neighborhood income, defined as the percentage of households with income below the federal poverty line (% below FPL) in the patient's census tract. The following outcomes were compared between socioeconomic groups: improvement in simple measure for assessing psoriasis activity (S-MAPA) score at 12 weeks, primary and secondary drug failure rates, and incidence of documented medication non-adherence.
  
  
  RESULTS
  Those patients living in relatively poorer neighborhoods (% below FPL ≤ 10%) experienced a significantly decreased improvement in S-MAPA score at 12 weeks of biologic treatment when compared to those in relatively richer neighborhoods (% below FPL >10%), 23.2% vs. 45.5%, P=0.021. Patients living in poorer neighborhoods also had a significantly higher rate of primary drug failure when treated with biologics (34.7% vs. 18.4%, P=0.039) and were significantly more likely to have ≥ 1 documented instance of medication non-adherence when treated with biologics (45.5% vs. 8.8%, P < 0.001).
  
  
  CONCLUSIONS
  Retrospective design, small sample size
  
  
  CONCLUSIONS
  Our study offers preliminary data that suggests lower socioeconomic status may be associated with decreased clinical response to the biologic agents, presumably through decreased medication adherence.
authors.forename: Eric P
authors.initials: EP
authors.lastname: Sorensen
authors.forename: Haitham
authors.initials: H
authors.lastname: Algzlan
authors.forename: Shiu-chung
authors.initials: SC
authors.lastname: Au
authors.forename: Caren
authors.initials: C
authors.lastname: Garber
authors.forename: Kristina
authors.initials: K
authors.lastname: Fanucci
authors.forename: Michelle Bichchau
authors.initials: MB
authors.lastname: Nguyen
authors.forename: Alice B
authors.initials: AB
authors.lastname: Gottlieb
mesh_terms: D001685:Biological Factors / Q000008:administration & dosage* / Q000191:economics*; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D011565:Psoriasis / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D012189:Retrospective Studies; D012923:Social Class; D016896:Treatment Outcome
chemical_list: D001685:Biological Factors