Racial and Ethnic Disparities in Disease Activity in Patients with Rheumatoid Arthritis

Abstract

Background Observational studies of patients with rheumatoid arthritis have suggested that racial and ethnic disparities exist for minority populations. We compared disease activity and clinical outcomes across racial and ethnic groups using data from a large, contemporary United States registry. Methods We analyzed data from two time periods (2005-2007 and 2010-2012). The Clinical Disease Activity Index was examined as both a continuous measure and as dichotomous measures of disease activity states. Outcomes were compared in unadjusted and a series of cross-sectional and longitudinal multivariable regression models. Results For 2005-2007, significant differences of mean disease activity level (p<0.001) were observed across racial and ethnic groups. Over the five-year period, modest improvements in disease activity were observed across all groups, including whites [3.7 (95% CI 3.2 - 4.1) compared with African Americans [4.3 (95% CI 2.7 – 5.8)] and Hispanics [2.7 (95% CI 1.2 – 4.3)]. For 2010-2012, significant differences of mean disease activity level persisted (p<0.046) across racial and ethnic groups, ranging from 11.6 (95% CI 10.4-12.8) in Hispanics to 10.7 (95% CI 9.6-11.7) in whites. Remission rates remained significantly different across racial/ethnic groups across all models for 2010-2012, ranging from 22.7 (95% CI 19.5-25.8) in African Americans to 27.4 (95% CI 24.9-29.8) in whites. Conclusions Despite improvements in disease activity across racial and ethnic groups over a 5-year period, disparities persist in disease activity and clinical outcomes for minority groups versus white patients.

Predictors of Treatment Initiation with Tumor Necrosis Factor-α Inhibitors in Patients with Rheumatoid Arthritis

“…[8][9][10] This disparity may lead to differences in such clinical outcomes as greater disease activity and lower remission rates in these patient subgroups. 11 Reduction in overall health services utilization costs through sustained remission in RA is well documented. 12 Therefore, from a payer's point of view, it is very important to understand and address potential disparities in the use of biologics among RA patients in order to control future health care costs.…”

Effects of Language, Insurance, and Race/Ethnicity on Measurement Properties of the PROMIS Physical Function Short Form 10a in Rheumatoid Arthritis

“…Previous studies have shown that sociodemographic factors can affect multiple aspects of care in RA, including mortality and disability, disease activity, prevalence of comorbidities, patient‐reported outcomes, access to treatment/health services, treatment preferences and medication adherence, health literacy, and trust in providers . A better understanding of the effects of sociodemographic factors on the validity of PROMIS physical function measures will determine their generalizability across diverse communities.…”

Using subcutaneous methotrexate to prolong duration of methotrexate therapy in rheumatoid arthritis

“…We also found that African Americans were less likely to be on SC MTX than Caucasian patients. It has been previously shown that African American patients are less likely to be prescribed biologic agents than Caucasians and are also less likely to achieve clinical remission than Caucasian patients (24). However, it is unclear whether this is due to the fact that RA may be more aggressive in some ethnic groups, differences in patient preference regarding treatment, or some bias in prescribing (25)(26)(27).…”