Racial and ethnic disparities in disease activity and function among persons with rheumatoid arthritis from university‐affiliated clinics

Abstract

Background Health outcomes in rheumatoid arthritis (RA) have improved significantly over the past two decades. However, research suggests that disparities exist by race/ethnicity and socioeconomic status, with certain vulnerable populations remaining understudied. Our objective was to assess disparities in disease activity and function by race/ethnicity and explore the impact of language and immigrant status at clinics serving diverse populations. Methods A cross-sectional study of 498 adults with confirmed RA at two rheumatology clinics, a university hospital clinic and a public county hospital clinic. Outcomes included the Disease Activity Score 28 (DAS-28), its components, and a measure of function, the Health Assessment Questionnaire (HAQ). We estimated multivariable linear regression models including interaction terms for race/ethnicity and clinic site. Results After adjusting for age, gender, education, disease duration, rheumatoid factor and medication use, clinically meaningful and statistically significant differences in DAS-28 and HAQ were seen by race/ethnicity, language, and immigrant status. Lower disease activity and better function was observed among Whites compared to non-Whites at the university hospital. This same pattern was observed for disease activity by language (English compared to non-English) and immigrant status (U.S.-born compared to immigrant) at the university clinic. No significant differences in outcomes were found at the county clinic. Conclusion The relationship between social determinants and RA disease activity varied significantly across clinic setting with pronounced variation at the university, but not at the county clinic. These disparities may be a result of events that preceded access to subspecialty care, poor adherence, or healthcare delivery system differences.

Psychological Factors Associated with Response to Treatment in Rheumatoid Arthritis

“…Few studies have investigated the interaction between cultural/geographical background and response to treatment in RA. Recent studies found racial/ethnic differences in PROs of function and global disease assessments [147,148]. These discrepancies could result from differences in interpretation and completion of outcome instruments, which, although often transculturally validated, may not guarantee transcultural comparability of results.…”

Ethnic aspects of rheumatic diseases

“…[23] обратили внимание на некоторые особенности, зависящие от этнического происхождения и социально-экономического статуса пациентов. У боль-шой группы больных РА (n=498) с использованием моде-ли мультивариабельной линейной регрессии авторы про-анализировали следующие параметры: пол, возраст, обра-зование, активность заболевания по DAS 28, качество жизни (HAQ) и др.…”

Insufficient Reporting on Race and Ethnicity in Randomized Trials for Patients With Rheumatoid Arthritis: Comment on the Article by Simsek et al

“…We believe that increased reporting of patient demographic information, particularly race and ethnicity, could shed light on the reasons for the disparities in outcomes seen in minority patients in clinical practice (7). This increased reporting will also improve the interpretability of results from trials of biologic agents in RA to specific patient populations and clarify the generalizability of these results for our increasingly diverse patient population.…”