Factors that underlie the disparity in quality of life among Asian Americans with chronic pruritus Pubblico

Abstract

INTRODUCTION: Chronic pruritus significantly impacts quality of life (QoL) and differentially impacts individuals by race. In a veterans population, our previous research study found that non-whites have greater pruritus-specific QoL impact. Current literature suggests that Asian or Pacific Islanders (API) have a higher prevalence and burden of disease from chronic pruritus, but the etiology of this disparity remains unclear. API are traditionally grouped into one population or grouped as “Other”, but are in reality a heterogeneous group. 

 

METHODS: We investigated potential factors mediating this disparity in an API population of 47 pruritic and 30 non-pruritic subjects compared to a previously studied veterans population. Surveys assessing QoL (ItchyQoL) and itch severity were given to pruritic subjects, and demographics and medical distrust to all subjects. 

 

RESULTS: The API group had a similar (p=0.27) mean itch severity score of 4.8 (SD=2.9) to that of the veterans (5.2, SD 2.3). As in the veteran group, higher itch severity and younger age were significantly associated with higher scores in the total and all three subdomains of the ItchyQoL in the API population (p<0.05). However, in the API group, female sex was significantly associated with QoL impact as well. As in the veterans group, itch had disproportionately higher emotional rather than functional or symptomatic impact on QoL among API. However, statistically significant differences in individual ItchyQoL item means between pruritic API and veterans of different races were also found among all three subscales, especially under the emotional domain. With relation to mean scores, we found certain ItchyQoL items to be drivers under each subscale. In the symptomatic domain, APIs are significantly concerned for residual scarring and seasonal aggravation. In the functional domain, economic costs of managing their itch and disturbances with sleep and concentration were noted, and they also endorsed feelings of frustration or concern that their pruritic skin condition will last forever under the emotional subdomain. Finally, we found differences in medical provider trust between pruritic and non-pruritic subjects; compared to non-pruritic API, pruritic subjects felt less comfortable telling their physicians “anything”(T = -2.07, p=0.04). However, pruritic API more strongly disagreed that “their physicians pretended to know something he or she did not know”(T=-2.60, p=0.011).

 

CONCLUSIONS: Dissimilarities in the impact of chronic pruritus among different racial groups in specific emotional, functional, and symptomatic factors from their chronic pruritus are highlighted with our larger sample of API. Further exploration of potential sociocultural differences between API ethnicities that may mediate these disparities in pruritus are needed.  

Table of Contents

CHAPTER 1: Introduction.................................................................................................................................................................... 1

1.1 Introduction and rationale................................................................................................................................................. 1

1.2 Problem statement.................................................................................................................................................................... 3

1.3 Purpose statement..................................................................................................................................................................... 4

1.4 Research Aims................................................................................................................................................................................ 4

1.5 Significance statement............................................................................................................................................................ 5

1.6 Definition of terms..................................................................................................................................................................... 6

CHAPTER 2: Review of the Literature...................................................................................................................................... 7

2.1 “Globalization”of the US population.......................................................................................................................... 7

2.2 Quality of life research in dermatology................................................................................................................... 8

2.3 Quality of life impact of chronic pruritus.............................................................................................................. 9

2.4 Epidemiology of chronic pruritus among different global populations................................. 11

2.4.1 Disparities in chronic pruritus among East Asian populations................................................. 12

2.5 Factors in chronic pruritus quality of life from a veterans population study.................. 13

2.6 Healthcare system experiences and their influence on health seeking behaviors of Asian Americans           14

CHAPTER 3: Manuscript................................................................................................................................................................... 16

Abstract...................................................................................................................................................................................................... 18

Introduction........................................................................................................................................................................................... 21

Methods..................................................................................................................................................................................................... 22

Study Design.................................................................................................................................................................................... 22

Context and Recruitment..................................................................................................................................................... 23

Severity................................................................................................................................................................................................. 24

Quality of Life.................................................................................................................................................................................. 24

Race.......................................................................................................................................................................................................... 25

Medical provider trust............................................................................................................................................................ 25

Statistical Analysis....................................................................................................................................................................... 26

Results......................................................................................................................................................................................................... 27

Population.......................................................................................................................................................................................... 27

Itch Severity..................................................................................................................................................................................... 27

Quality of Life.................................................................................................................................................................................. 27

Medical Provider Trust.......................................................................................................................................................... 30

Discussion................................................................................................................................................................................................. 30

Table I: Select demographic information of pruritic API cohort vs. veterans cohort................ 38

Table II: Analysis results of ItchyQoL and predictor variables...................................................................... 39

Table III: Medical provider trust results............................................................................................................................ 40

CHAPTER 4: Recommendations................................................................................................................................................. 41

REFERENCES............................................................................................................................................................................................... 45

APPENDIX I: ItchyQuant................................................................................................................................................................... 50

APPENDIX II: ItchyQoL Sample (English and Korean Sample).................................................................... 51

APPENDIX III: PCAS Component: 8-Item Healthcare Provider Trust..................................................... 53

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Parola chiave	Chronic Pruritus Racial Disparity Asian American Pruritus Healthcare system distrust Quality of Life
Committee Chair / Thesis Advisor	Hussen, Sophia, Emory University
Committee Members	Chen, Suephy, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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