Racial Differences in Multimorbidity and Comorbidities in Rheumatoid Arthritis

Abstract

Objective To identify differences in multimorbidity and individual comorbidities among individuals with rheumatoid arthritis (RA), separated by race and ethnicity. Methods This case–control study within OptumLabs Data Warehouse from 2010 to 2019 matched RA cases (defined by 2 codes plus prescription of an RA drug) to non‐RA controls 1:1 on age, sex, race and ethnicity, region, index date of RA, and insurance coverage duration. We defined multimorbidity as the presence of ≥2 or ≥5 validated comorbidities. Logistic regression models calculated adjusted odds of multimorbidity with 95% confidence intervals (95% CIs) within each race and ethnicity. Results We identified 154,391 RA cases and 154,391 controls (mean age 59.6, 76% female). Black enrollees had the most multimorbidity ≥2/≥5 (73.1%, 34.3%); Asian enrollees had the least (52.4%, 17.3%). Adjusted odds of multimorbidity ≥2 and ≥5 in RA cases versus controls was 2.19 (95% CI 2.16–2.23) and 2.06 (95% CI 2.02–2.09), respectively. This increase was similar across race and ethnicity. However, we observed elevated occurrence of certain comorbidities by race and ethnicity versus controls (P < 0.001), including renal disease in White enrollees (4.7% versus 3.2%) and valvular heart disease in Black and White enrollees (3.2% and 2.8% versus 2.6% and 2.2%). Conclusion Multimorbidity is a problem for all RA patients. Targeted identification of certain comorbidities by race and ethnicity may be a helpful approach to mitigate multimorbidity.

Characteristics of race/ethnicity in trials leading to anti‐rheumatic drug approval for inflammatory arthritis by the US Food and Drug Administration

“…Thus, the degree of overrepresentation for white patients and underrepresentation for black patients in AS may be all overestimated, as were in PsA 3 . The degree of overestimation may be lower for RA, as a recent study with 154 391 enrollees showed a minor variation in racial/ethnic distribution from the 2020 national data 33 . Epidemiological data related to racial/ethnic distribution in different IAs is minimal.…”

“…3 The degree of overestimation may be lower for RA, as a recent study with 154 391 enrollees showed a minor variation in racial/ethnic distribution from the 2020 national data. 33 Epidemiological data related to racial/ethnic distribution in different IAs is minimal. More relevant high-quality studies should be conducted to provide a better reference source for clinical trial patients' involvement.…”