Black Rheumatic Disease Patients Less Likely to Receive Biologics

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In a study that explored the longitudinal racial disparities in rheumatoid arthritis treatment and emergency department use, black rheumatoid arthritis patients were found to be less likely to receive biologics and instead, be given a prescription for glucocorticoids, say researchers reporting at the annual meeting of the American College of Rheumatology on Friday.

This single-center study was led by Michael George, M.D., M.S.C.E., assistant professor of medicine at the University of Pennsylvania in Philadelphia. It included electronic health record data (2010- 2018) from 639 black patients and 991 white patients with rheumatoid arthritis and at least one disease-modifying antirheumatic (DMARD) script.

Patient demographics were measured at the baseline visit, while medication use and comorbidities were measured at baseline or at any follow-up visit. The number of outpatient visits and emergency department visits per year were also measured.

Compared to white patients, black patients were more likely to be older, have higher body mass index, former or current smoking status, and have higher rates of diabetes and cardiovascular disease (p< 0.0001).

Prednisone use was significantly more frequent in black patients compared with white patients (79.3 percent versus 69.1 percent; p< 0.0001). Conventional synthetic DMARD use was also significantly more frequent in black patients compared with white patients (96.7 percent versus 93.5 percent; p=0.005). However, the respective use of biologics was 67.0 percent and 74.3 percent ( p=0.001), indicating that biologic use was significantly less common among black patients compared with white patients.

“These differences in treatments could lead to worse outcomes or increased steroid side-effects” in black patients, researchers wrote.

Meanwhile, black patients had more emergency department visits that white patients, with a median 0.24 visits per patient per year compared with no visits per year, respectively, (p<0.0001). The authors noted that that while this higher emergency department visit use could be related to higher comorbidity rates, differences in geographic location could also influence the location of care.

“This study helps draw attention to disparities in the treatment of rheumatoid arthritis. Patients and physicians should be aware that these disparities exist,” Dr. George said. “ A key next step is understanding the key drivers of these disparities and finding ways to address the on an individual and systemic level.”

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REFERENCE

ABSTRACT: 0044.“Characterization of Racial Disparities in Rheumatoid Arthritis Treatment Choice and Location of Care.” The annual meeting of the American College of Rheumatology. 11:00 AM, Friday, Nov. 6, 2020.