Black patients with rheumatoid arthritis less likely than whites to receive biologics
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Patients with rheumatoid arthritis who are Black are less likely to receive a biologic, and more likely to use glucocorticoids, than those who are white, according to a speaker at ACR Convergence 2020.
“Previous studies have identified important racial and ethnic disparities in rheumatoid arthritis outcomes,” Michael George, MD, an assistant professor at the University of Pennsylvania, said in a recorded poster presentation at the virtual meeting. “In this study, we aimed to further explore these disparities by examining differences in rheumatoid arthritis treatment and emergency department use, using data from a single tertiary academic medical center.”
George and colleagues extracted structured, de-identified data from 2010 to 2018 on 1,831 patients who had at least two diagnoses of RA, and at least one DMARD prescription during the follow-up period, from electronic health records. The researchers measured follow-up from each patient’s first visit to their last within the 2010 to 2018 study period. Patient demographics were assessed at baseline visit, with medication use and comorbidities recorded either at baseline or at any point during follow-up.
In all, 991 of the included patients were white and 639 were Black. The average follow-up duration among all patients was 6.97 years. The researchers measured the average number of outpatient visits and ED visits each year — limited to visits within the health system — during the follow-up period. They then compared differences in patient characteristics and visits among those who were Black versus white, based on standard t-test and 2 analysis.
According to the researchers, Black patients were more likely to be older, have higher BMI, be former or current smokers, and have higher rates of diabetes and cardiovascular disease (P < .0001). Among those included in the study, 79.3% of Black patients used prednisone, compared with 69.1% of white patients (P < .0001). In addition, 96.7% of Black patients used conventional synthetic DMARDs, compared with 93.5% of white patients (P = .005). Meanwhile, the use of biologics was significantly more common among white patients, at 74.3%, than among Black patients, at 67% (P = .001).
Lastly, Black patients had significantly more ED visits, with a median of 0.24 visits per patient per year, compared with 0 for white patients.
“Among a population of patients with rheumatoid arthritis at an academic medical center, patients who were Black were less likely to receive a biologic and more likely to receive glucocorticoids during follow-up, which potentially could contribute to poorer outcomes,” George said.
“Patients who were Black also had higher rates of emergency department visits, although these differences could be due in part to higher rates of comorbidities, or to differences in geography, with patients living closer more likely to visit an emergency department within the health system,” he added. “Continued studies to identify and address drivers of racial disparities in the treatment of rheumatoid arthritis are of critical importance.”
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George M. Abstract 0044. Presented at: ACR Convergence 2020; November 5-9, 2020 (virtual meeting).
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