Health Disparities Among Hispanics With Rheumatoid Arthritis

Abstract

Objective The aim of this study was to evaluate referral and treatment delays by ethnicity/race in patients with rheumatoid arthritis (RA) treated at an academic rheumatology center. Methods We reviewed the medical records of all RA patients evaluated at an outpatient clinic between 2011 and 2016 to identify newly diagnosed and naive-to-treatment patients. We determined the durations between symptom onset and first rheumatology visit and time to initiate treatment. Data extraction included referral source, demographics, treatment, and laboratory tests. Routine use of a multidimensional health assessment questionnaire allowed us to calculate baseline RAPID3 (routine assessment of patient index data 3) scores. Comparisons between self-reported ethnicity/race groups were performed. We used logistic regression models to analyze associations between baseline variables and early referral. Results Data from 152 disease-modifying antirheumatic drug-naive RA patients were included in the study; 35% were white, 37% black, 20% Hispanic, and 8% other. The range in median time to first rheumatology visit was 6 to 8 months for all patient groups, except Hispanic. This group had a median time of 22.7 months (p = 0.01). The referral pattern was considerably variable between-groups; 40% of Hispanic patients were self-referred (p = 0.01). There were no statistically significant between-group differences for time to treatment initiation according to ethnicity/race. RAPID3 scores (p = 0.04) and erythrocyte sedimentation rates (p = 0.01) were significantly higher in the black and Hispanic groups. A high C-reactive protein value at baseline was associated with earlier referral. Conclusions There is significant delay in initial presentation to a rheumatologist that was associated with a higher disease severity at presentation, especially for Hispanic patients.

Hispanic/Latino Perspectives on Hearing Loss and Hearing Healthcare: Focus Group Results

“…Participants frequently noted that general practitioners did not discuss hearing loss or refer for testing, mirroring studies revealing disparities in specialty referrals for patients seen in primary care, such as significantly delayed or disparate referrals for Hispanic patients for chronic renal failure (Ifudu et al 1999), coronary artery or congestive heart failure (Cook et al 2009), mental healthcare for the treatment of depression and anxiety (Laomasino et al 2011), and treatment for rheumatoid arthritis (Mariam et al 2020). A lack of referral for a hearing test expressed by participants in the present study also aligns with the findings of McKee et al (2018), Carlson et al (2019), and McMahon et al (2021), whose qualitative study results revealed that primary care providers did not discuss or minimized hearing loss, screenings, or hearing devices at appointments.…”

Health Equity in Rheumatology: A Global Health Perspective

“…Based on evidence in the literature spanning time frames of 2011-2016 and 1997-2015, respectively, African American and Hispanic patients had worse disease manifestations and outcomes than Caucasian patients with rheumatoid arthritis in the USA, which persisted even after adjusting for age and gender. 36,37 Another recent literature review, published by researchers from Nigeria and the UK, studying the diagnosis and management of rheumatoid arthritis among low-income populations in resource-poor countries, particularly in Sub-Saharan Africa, demonstrated significant health inequities. 38 Patients in these countries lacked the necessary resources (including financial resources, social support and availability of specialists) for the timely diagnosis and management of their disease, leading to disease worsening, disability and an inability to work.…”

Disparities in burden of disease in patients with rheumatoid arthritis across racial and ethnic groups

“…Recent studies indicate differential risk of RA by different demographic groups (e.g., race/ethnicity, socioeconomic status (SES), educational attainment) [ 4 ]; variances in use patterns of biologic medications for different racial/ethnic groups [ 5 ]; and lower functional status across SES quintiles within these groups [ 6 ]. Additional studies found disparities in time from symptom onset to first RA treatment, especially among Hispanics [ 7 ]. However, there is still a lack of large-scale studies investigating these disparities in clinical and patient-reported outcomes (PROs) of RA by race/ethnicity groups [ 8 ].…”