Worse outcomes linked to ethnicity for early inflammatory arthritis in England and Wales: a national cohort study

Abstract

Objective To assess variability in care quality and treatment outcomes across ethnicities in early inflammatory arthritis (EIA). Methods We conducted an observational cohort study in England and Wales from May 2018-March 2020, including patients with a suspected/confirmed EIA diagnosis. Care quality was assessed against six metrics defined by national guidelines. Clinical outcomes were measured using DAS28. Outcomes between ethnic groups (‘White’, ‘Black’, ‘Asian’, ‘Mixed, ‘Other’) were compared, and adjusted for confounders. Results 35,807 eligible patients were analysed. Of those, 30,643 (85.6%) were White and 5,164 (14.6%) were from ethnic minorities: 1,035 (2.8%) Black; 2,617 (7.3%) Asian; 238 (0.6%) Mixed; 1,274 (3.5%) Other. 12,955 patients had confirmed EIA, of whom 11,315 were White and 1,640 were from ethnic minorities: 314 (2.4%) Black; 927 (7.1%) Asian; 70 (0.5%) Mixed; 329 (2.5%) Other. 14,803 patients were assessed by rheumatology within three weeks, and 5,642 started treatment within six weeks of referral. There were no significant differences by ethnicity. Ethnic minority patients had lower odds of disease remission at three months (adjusted odds ratio 0.79 [95% CI: 0.65,0.96]) relative to White patients. Ethnic minorities were significantly less likely to receive initial treatment with methotrexate (0.68 [0.52-0.90]) or with glucocorticoids (0.63 [0.49-0.80]). Conclusion We demonstrate that some ethnic minorities are less likely to achieve disease remission in three months following EIA diagnosis. This is not explained by delays in referral or time to treatment. Our data highlight the need for investigation into the possible drivers of these inequitable outcomes and reappraisal of EIA management pathways.

Crying out for equity: outcomes of rheumatic diseases confounded by ethnicity

“…This directly contrasts with previous perceptions that some ethnic minority groups, such as South Asians developed less severe diseases with rheumatoid arthritis (RA). Adjustment for the social class has not changed the differences in outcomes [3]. There have been multiple other studies over the last decade in the UK demonstrating poorer outcomes in BAME patients [4,5].…”

Accessing care during the pandemic: A UK wide survey of people with rheumatoid arthritis and adult juvenile inflammatory arthritis during the COVID‐19 pandemic

“…The participation of men and those from ethnic minority backgrounds remained low and these patients often have poorer outcomes (Adas et al., 2023). This is often the case with such surveys and work is being performed to understand and address this.…”

“…Other key findings showed that people did not feel their concerns were adequately addressed when engaging with a virtual consultation. Relatively few participants suggested that an increased length in the consultation time would be necessary, which is The participation of men and those from ethnic minority backgrounds remained low and these patients often have poorer outcomes (Adas et al, 2023). This is often the case with such surveys and work is being performed to understand and address this.…”

Prodromal symptoms of rheumatoid arthritis in a primary care database: variation by ethnicity and socioeconomic status

“…Meanwhile, there are well-documented ethnic and socio-economic disparities in clinical outcomes for RA (7)(8)(9), suggesting a lack of health equity along the patient pathway. There is evidence that ethnicity and socio-economic status influence the symptomatic presentation to primary care (8,10) and patients of non-White ethnicity and low socioeconomic status may be more likely to present with "atypical" musculoskeletal symptoms than their White or more affluent counterparts.…”