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New research demonstrates psoriasis is twice as common among African-Americans as previously believed, but internet coverage of Blacks with psoriasis lacking
By Michael Paranzino, February 7, 2005
A new study in the Journal of the American Academy of Dermatology (JAAD) has demonstrated that psoriasis is twice as common among African-Americans as previously believed. This work should prove helpful to the many African-Americans who may presently feel isolated by their disease. However, a review of leading internet search engines suggests that the internet is deficient when it comes to examining African-Americans with psoriasis.
Psoriasis Cure Now! reviewed the three leading internet search engines, Google, Yahoo, and MSN, which account for more than three-quarters of all searches performed by internet users, according to recent estimates. These three search engines have indexed an average of nearly 3.5 million web pages that mention psoriasis. However, those pages include only an average of 28,000 that mention both psoriasis and African-Americans, an average of just 0.8%.
Similarly, of the first 500 pictures indexed under the search term “psoriasis” on each of those leading search engines, an average of just 4.7 were of Black people, an average of just 0.9% of the psoriasis-related images on the web.
THE RESULTS
Search engine
Number of pages that mention psoriasis
Number of psoriasis pages that also mention African-Americans
Number of images among first 500 for “psoriasis” that include dark skin
Google
4.1 million
23,300
1
MSN
4.5 million
27,800
4
Yahoo
1.8 million
34,200
9
AVERAGES
3,467,000
28,440 (0.8%)
4.7 (0.9%)
See methodological notes.*
It appears that content on the World Wide Web reflects the longstanding and erroneous belief that psoriasis, at least in the United States, was a “Caucasian disease.” After all, the conventional wisdom has been that about 0.7% of African-Americans have psoriasis.
But the JAAD study shows that psoriasis is in fact common among African-Americans. The study, conducted by a team lead by Joel M. Gelfand, MD of the University of Pennsylvania, found that 1.3% of African-American adults have been diagnosed with psoriasis, versus 2.5% of Caucasian adults. (The study excluded children under 18 as well as adults whose psoriasis had not been diagnosed by a physician.) While that means psoriasis is twice as common among Caucasians as among Blacks, it is not the four-to-one ratio previously believed.
This also suggests there may be from 500,000 to 750,000 African-Americans with psoriasis. (Estimates of the number of Americans with psoriasis are all over the map. To be conservative, Psoriasis Cure Now! uses a point on the low side of the National Institutes of Health’s official range of “between 5.8 and 7.5 million people” in the United States.)
Clearly, this is a lot of Americans whose disease has received little attention.
But the Gelfand et al. study also hints at other questions that merit further investigation. Most importantly, the data suggest there may be disparities in psoriasis severity between whites and African-Americans. African-Americans reported a higher incidence of 3-10 palm-sized units of psoriasis involvement on their bodies, while Caucasians reported a higher incidence of 1-2 palms of psoriasis coverage. (The small number of African-Americans interviewed with psoriasis precludes making conclusions based on this evidence alone, but it certainly warrants further study.)
These possible differences, if they show up in larger studies, could point us towards a genetic basis, a difference in access to health care, or other causes. But whatever the cause or causes, the answer is important. If there are genetic differences that account for this, gene studies could help us further pinpoint genes that give rise to psoriasis susceptibility. If the results, instead, point to differences in access to health care, this would be important to know for ongoing public policy debates about insurance coverage, Medicaid, and access to cutting-edge psoriasis treatments.
Clearly, we need more research on these issues. Psoriasis Cure Now! has written to the Congressional Black Caucus, NIH’s National Center on Minority Health and Health Disparities, and other leaders urging additional research on this and related issues of concern to Americans with psoriasis and psoriatic arthritis.
No psoriasis patient should feel alone. After all, there are 6.5 million people with psoriasis and/or psoriatic arthritis just in the United States. But for a racial minority who has been told, consciously or unconsciously, that they have a disease that is “rare” for their racial group, those feelings of isolation could be exacerbated.
The JAAD study has dispelled the notion that psoriasis is rare among African-Americans. We hope that this Psoriasis Cure Now! report on the dearth of web content related to African-Americans with psoriasis will lead to more and better information for these patients who may even be facing more severe psoriasis than the average Caucasian with the disease.
!!!
* Methodological notes: The figures above are from searches conducted on February 5, 2005. Three separate searches were done on each search engine to gauge the number of pages that both mention “psoriasis” and also mention African-Americans. The search with the biggest number of hits was included here. The three search terms used were “African-American,” “African-Americans,” and “Blacks.”
Of course, this is an unscientific measure of how many web pages discuss psoriasis among African-Americans. The results are both under- and over-inclusive. For example, many pages mention both terms but in separate articles; this is not really a discussion of psoriasis among African-Americans, making the results over-inclusive. On the other hand, while we used the search term that provided the biggest number of hits, no doubt this missed some pages that discussed African-American psoriasis using an alternate term. For example, for Google and Yahoo, the term “African-American” produced the most hits on “psoriasis” pages; but for MSN, the term “Blacks” produced more hits.
Nevertheless, on balance, we believe this method gives a valid sense of the state of the web today. A qualitative analysis, examining perhaps the first several hundred web sites that discuss psoriasis among African-Americans, is beyond the scope of this Issue Brief, but would be a worthwhile project that we may undertake in the future.
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