The overall objective of this K23 award proposal is to provide support for the additional training and experience necessary for the candidate, Junko Takeshita, MD, PhD, to transition from recent post-doctoral trainee and current Instructor in Dermatology to an independent patient-oriented investigator with a focus on health and healthcare disparities in psoriasis. Specifically, the aims of this proposal are to identify, defin, and understand disparities between African American and Caucasian Medicare beneficiaries in the treatment of psoriasis. We hypothesize that: 1) initiation of specific psoriasis therapies and persistence on therapies are different between African American and Caucasian patients with psoriasis, and 2) there are important differences in patient-level factors such as perceptions of psoriasis and attitudes towards treatments between the two racial groups that contribute to differential treatment of psoriasis. As clinicians are currently unaware of existing disparities in psoriasis treatment, we seek to shift current clinical practice paradigms with this proposal by newly identifying and establishing an understanding of racial disparities in the treatment of psoriasis with the goal of reducing any identified disparities and ultimately improving treatment and clinical outcomes, particularly among African American patients with psoriasis. A sequential mixed methods approach will be utilized to address the proposed aims: i) first, a quantitative longitudinal cohort study using Medicare data will be performed in order to compare initiation of therapies and persistence on therapies between African American and Caucasian Medicare beneficiaries with psoriasis; and ii) second, a qualitative study, informed by results from the quantitative study, will be performed using semi-structured interviews and freelists in order to identify patient- level determinants of the identified psoriasis treatment disparities between African Americans and Caucasians. In order to achieve these goals, the candidate will need training in three critical areas: 1) use of Medicare claims data; 2) disparities research methods; and 3) qualitative and mixed methods research. The candidate's training plan, which includes a combination of didactic coursework, practical experience through the completion of her proposed research, and directed mentorship from her expert mentoring team over the five year award period, will enable her to launch a successful career as an independent investigator in patient-oriented research and make important contributions to the field of dermatology via the study of disparities in the care of psoriasis.

Public Health Relevance

Psoriasis is a common chronic inflammatory disease of the skin that affects 2-4% of the general population. The majority of patients with psoriasis do not receive adequate therapy to control their disease, and African Americans may at particular risk of being undertreated. This project aims to identify and better understand racial disparities in th treatment of psoriasis with the ultimate goal of improving treatment of psoriasis for racial minority populations.

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Mentored Patient-Oriented Research Career Development Award (K23)
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Arthritis and Musculoskeletal and Skin Diseases Special Grants Review Committee (AMS)
Program Officer
Cibotti, Ricardo
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University of Pennsylvania
Schools of Medicine
United States
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Ogdie, Alexis; Kay McGill, Neilia; Shin, Daniel B et al. (2018) Risk of venous thromboembolism in patients with psoriatic arthritis, psoriasis and rheumatoid arthritis: a general population-based cohort study. Eur Heart J 39:3608-3614
Fischer, Alexander H; Shin, Daniel B; Gelfand, Joel M et al. (2018) Health care utilization for psoriasis in the United States differs by race: An analysis of the 2001-2013 Medical Expenditure Panel Surveys. J Am Acad Dermatol 78:200-203
Takeshita, Junko; Shin, Daniel B; Ogdie, Alexis et al. (2018) Risk of Serious Infection, Opportunistic Infection, and Herpes Zoster among Patients with Psoriasis in the United Kingdom. J Invest Dermatol 138:1726-1735
Ogdie, Alexis; Grewal, Sungat K; Noe, Megan H et al. (2018) Risk of Incident Liver Disease in Patients with Psoriasis, Psoriatic Arthritis, and Rheumatoid Arthritis: A Population-Based Study. J Invest Dermatol 138:760-767
Takeshita, Junko; Grewal, Sungat; Langan, Sinéad M et al. (2017) Psoriasis and comorbid diseases: Epidemiology. J Am Acad Dermatol 76:377-390
Fischer, Alexander H; Shin, Daniel B; Margolis, David J et al. (2017) Racial and ethnic differences in health care utilization for childhood eczema: An analysis of the 2001-2013 Medical Expenditure Panel Surveys. J Am Acad Dermatol 77:1060-1067
Jariwala, Neha; Benoit, Bernice; Kossenkov, Andrew V et al. (2017) TIGIT and Helios Are Highly Expressed on CD4+ T Cells in Sézary Syndrome Patients. J Invest Dermatol 137:257-260
Noe, M H; Grewal, S K; Shin, D B et al. (2017) Increased prevalence of HCV and hepatic decompensation in adults with psoriasis: a population-based study in the United Kingdom. J Eur Acad Dermatol Venereol 31:1674-1680
Benoit, Bernice M; Jariwala, Neha; O'Connor, Geraldine et al. (2017) CD164 identifies CD4+ T cells highly expressing genes associated with malignancy in Sézary syndrome: the Sézary signature genes, FCRL3, Tox, and miR-214. Arch Dermatol Res 309:11-19
Grewal, S K; Wan, J; Denburg, M R et al. (2017) The risk of IgA nephropathy and glomerular disease in patients with psoriasis: a population-based cohort study. Br J Dermatol 176:1366-1369

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