title: Inequalities in access to biological treatments for psoriasis: results from the Italian Psocare registry.
abstract: BACKGROUND
  Limited evidence is available on the impact of socioeconomic factors on drug prescriptions for psoriasis.
  
  
  OBJECTIVE
  To investigate factors influencing prescription of conventional vs. biological treatment for patients with psoriasis, based on the Italian Psocare registry, with a special focus on socioeconomic factors.
  
  
  METHODS
  This was a cross-sectional study evaluating the baseline data of patients included in the Psocare registry. All of the consecutive adult patients with a diagnosis of chronic plaque psoriasis or psoriatic arthritis who were prescribed a systemic treatment for psoriasis at participating centres were included in this study. Univariate and multivariate analyses of the baseline factors associated with a biologics prescription were performed.
  
  
  RESULTS
  From September 2005 to September 2009, 12 838 patients were identified. A multivariate analysis revealed that, among other factors, completing a level of education higher than lower secondary school and being employed as a manager or a professional were independent factors associated with a biologics prescription at entry in the registry. Additional analyses on the association between these two variables and a severe psoriasis condition [Psoriasis Area Severity Index (PASI) score > 20] revealed a significantly increasing trend of severe disease towards lower educational attainment, while unemployed patients were more likely to have a more severe condition compared with the other categories of workers.
  
  
  CONCLUSIONS
  We documented inequalities of drug prescriptions for psoriasis in Italy, with a trend towards a higher frequency of prescription for more expensive biologics in higher socioeconomic sectors of the population.
authors.affiliation: Centro Studi GISED, Bergamo, Italy.|Dermatology Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Naldi
authors.affiliation: Centro Studi GISED, Bergamo, Italy.|Dermatology Department, Inselspital University Hospital, Bern, Switzerland.
authors.forename: S
authors.initials: S
authors.lastname: Cazzaniga
authors.affiliation: Centro Studi GISED, Bergamo, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Di Mercurio
authors.affiliation: Villa Santa Maria Institute, Tavernerio, Italy.|Semeion Research Centre, Rome, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Grossi
authors.affiliation: Department of Epidemiology, Lazio Region, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Addis
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001688:Biological Products / Q000600:supply & distribution / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D003879:Dermatologic Agents / Q000600:supply & distribution / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D055553:Prescription Drugs / Q000600:supply & distribution / Q000627:therapeutic use; D011565:Psoriasis / Q000188:drug therapy*; D012042:Registries; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D001688:Biological Products; D003879:Dermatologic Agents; D055553:Prescription Drugs