Black, Hispanic patients with RA exhibit higher disease activity, worse functional status
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Black and Hispanic patients with rheumatoid arthritis have higher disease activity and lower self-reported functional status compared with white patients, according to data presented at ACR Convergence 2021.
The data reflect ongoing racial disparities in RA that have persisted throughout a 7-year period of improving disease activity across all racial and ethnic groups, the presenter said.
“This is an area that has been under studied in rheumatoid arthritis,” Jacqueline O’Brien, ScD, a clinical epidemiologist at the disease registry provider CorEvitas, formerly known as Corrona, told attendees at a virtual press conference. “We have a rich data source following RA patients over many years, systematically collecting information about patient characteristics, their clinical progress and the medications people take. We have the ability to look at this large cohort with systematic clinical assessments collected over time. So, we thought this was an excellent opportunity.”
To determine whether clinical outcomes differ by race and ethnicity in RA within their own registry population, O’Brien and colleagues studied data from the more than 56,000 patients across 42 states contained in the CorEvitas’ RA Registry. The researchers included patients with at least one visit during two time periods — 2013 to 2015 and 2018 to 2020 — selecting the first visit from the first period and the last visit in the second period for analysis. Race and ethnicity were self-reported at enrollment, while Clinical Disease Activity Index (CDAI) scores were obtained at each visit.
The primary outcome was CDAI at both examined visits. Secondary outcomes included the proportion of patients in low disease activity — defined as a CDAI score of 10 or less — or remission — a CDAI score of 2.8 or less — and HAQ-disability index at each visit. The researchers assessed the mean change in CDAI and HAQ-disability index from the first to the last visit, as well as the probability of achieving LDA and remission at the second included visit. Linear regression models were adjusted for demographics, clinical characteristics and site.
A total of 9,363 patients with RA were included in the analysis. Among these patients, 8,142 were white, 527 were Black, 545 were Hispanic and 149 were Asian.
According to the researchers, the adjusted analyses demonstrated that although proportions of patients in LDA and remission were similar across all groups at visit one, a significantly lower proportion of Hispanic patients were in LDA and remission, compared with whites, at visit 2.
Functional status declined over time for all groups, represented by greater mean HAQ-disability index scores at visit two versus visit one. However, compared with white patients, Hispanic patients demonstrated significantly higher mean HAQ-DI scores at visit one, and both Black and Hispanic patients had significantly higher mean HAQ-DI scores at visit two.
Longitudinally, CDAI scores improved for all groups from visit one to two, the researchers wrote. However, Hispanic patients improved significantly less than white patients. There were no statistically significant differences in LDA or remission achievement, or change in HAQ-disability index, over time across groups.
“The broader implication is that the study tells us that, in a population of people who have access to a clinic, have access to treatment, that we're seeing a lot of differences between the racial and ethnic groups,” O’Brien said. “I think the findings can serve as a reminder to clinicians that it's important to be mindful that patients are coming from diverse racial and ethnic backgrounds. They may have different needs in order to achieve similar levels of success with advanced therapy. I think it's important to explore this topic in other cohorts and that we dig deeper into the reasons for why these disparities persist in RA.”
“There are many factors that contribute to inequality, including but not limited to access to care, socioeconomic status, systemic racism and other social determinants of health,” she added. “A key long-term goal is really recruiting diverse populations into future research. RA research has focused predominantly on white populations, and we need more information on the epidemiology of RA, the disease course, the patient reported outcomes in patients of different racial and ethnic backgrounds, and ultimately a complex multifactor solution is going to be needed to it to address health disparities in RA.”
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O’Brien J. Abstract 0604. Presented at: ACR Convergence 2021; November 5-9, 2021 (virtual meeting).
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