Introduction Patients with psoriatic arthritis (PsA) and ankylosing spondylitis (AS) may receive suboptimal care, and differences in care by race/ethnicity, sex, and insurance coverage are not well studied. Methods This was a descriptive, retrospective cross-sectional US claims database analysis utilizing the Medicaid multi-state segment of the IBM® MarketScan® Commercial Claims and Encounters Supplemental Database and Optum Insight Clinformatics® Data Mart database for 2019. Patients aged ≥ 18 years with PsA or AS and continuous medical and pharmacy coverage were included. Outcomes evaluated were prevalence and percentage of patients receiving biologic disease-modifying antirheumatic drugs (bDMARDs)/targeted synthetic DMARDs (tsDMARDs) or visiting a rheumatologist. Outcomes were stratified by race/ethnicity, sex, and insurance coverage, with outcomes determined for commercial insurance, Medicare, and Medicaid enrollees. Differences observed in outcomes were numerical in nature. Results Prevalences of PsA and AS were highest for Medicare enrollees (320 and 156 per 100,000 persons [0.32 and 0.16%], respectively) and lowest for Medicaid enrollees (132 and 71 per 100,000 persons [0.13 and 0.07%], respectively). White patients had the greatest prevalence versus patients of other races/ethnicities. Females had a higher prevalence of PsA than males, while AS prevalence was generally lower for females versus males for each insurance category. The percentage of patients prescribed bDMARDs/tsDMARDs was highest for commercial insurance enrollees (PsA 63%, AS 43%) and lowest for Medicare enrollees (PsA 21%, AS 11%). The proportion of patients who saw a rheumatologist was lower for Medicaid enrollees (PsA 12%, AS 10%) than for commercial insurance or Medicare enrollees (PsA 68%, 55%; AS 67%, 42%). For commercial insurance and Medicare enrollees, the percentage of patients visiting a rheumatologist was similar by race/ethnicity but higher for females versus males. Conclusions The prevalence and treatment of PsA and AS differs by race/ethnicity, insurance coverage, and sex in the USA. Efforts for improving access to care are needed to improve outcomes among all patients. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00370-4.

Background: Previous research has shown smoking to have a deleterious effect on Crohn's Disease (CD) development, with smoking being identified as both a risk factor for CD and associated with poorer outcomes. Previous studies have shown smoking cessation interventions are associated with decreased rates of CD flares and lower rates of disease progression. While previous guidelines have called for increased focus on counseling for smoking cessation amongst CD patients, little research to date has demonstrated to what extent this counseling is routinely provided in an outpatient setting. Methods: We examined the rates of education for tobacco cessation among current and former smokers during visits for CD captured within the National Ambulatory Medical Care Survey (2002-2018) (NAMCS) and The National Hospital Ambulatory Medical Care Survey (2002-2011) (NHAMCS) database, a nationally representative dataset of outpatient visits. Patients with CD were identified using the International Classification of Diseases (ICD)-9-Clinical Modification codes 555.x as well as ICD-10-Clinical Modification codes K50. We analyzed rates of tobacco cessation counseling among all CD visits as well as CD visits for current/former tobacco users. In addition, a multivariable logistic regression model was performed to determine factors associated with rates of tobacco cessation counseling, including age, race, gender, geographic area and insurance type.Results: Among all visits for CD, the overall rate of counseling for tobacco cessation was 2.0% (95% CI: 1.1-3.5). The rate of counseling amongst former or current smokers with CD was slightly higher at 5.4% (95% CI: 2.9-10.0). In addition, rates of smoking cessation counseling were not significantly different between smokers with and without CD (P 5 0.26). In a multivariable logistic regression model, tobacco cessation counseling was less likely at visits with Hispanic patients compared to White, non-Hispanic patients with an aOR (adjusted odds ratio) of 0.06 (95% CI 0.01-0.30). Conclusion(s): Overall, rates of counseling and education for smoking cessation in outpatient CD visits were infrequent. Furthermore, lower rates of smoking cessation were noted in Hispanic patients compared to non-Hispanic patients, a finding documented in several previous studies. Though smoking has an important role in disease course and development, these findings indicate that education on smoking cessation does not frequently occur in the outpatient setting for CD patients. Overall, this highlights the need for increased focus by providers on screening and counseling for tobacco cessation in CD patients.