Racial/Ethnic Disparities in Treatment for Rheumatic Diseases at A Large Medical Center

In a study presented at the American College of Rheumatology (ACR) Convergence 2021, researchers investigated racial and ethnic disparities in prescription of treatment for rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) among patients treated at a large medical center.

The primary outcome of this study was the relationship, if any, between patient race/ethnicity, residence in a disadvantaged neighborhood, and the incidence of being prescribed RA or SLE treatment.

The researchers used electronic medical records from a large urban hospital to identify patients treated for RA or SLE between January and September 2020. Independent variables included age, insurance, address and zip code, race/ethnicity, and sex. To calculate the area deprivation index score, the researchers utilized a neighborhood atlas website mapping tool. The dependent variables were rheumatologic medications, including prescribed biologic agents or conventional disease modifying anti-rheumatic drugs, as well as the prescription of steroids, non-steroidal medications, and opiates.

In total, 1,326 patients were identified, including 859 patients with RA, and 457 with SLE. There were 181 non-Hispanic White patients, 671 non-Hispanic Black patients, and 347 Hispanic patients.

The researchers identified higher area deprivation index scores among Black and Hispanic patients versus White patients for both RA and SLE (P <0.00001). Patients of color with RA were also more likely to have Medicaid health insurance compared with White patients with RA. However, the researchers found, physician prescribing did not vary according to area deprivation index scores (RA, P <0.878; SLE, P <0.08).

In summary, the authors wrote, “among patients with RA and SLE, Black [patients] and Hispanic [patients] are more likely to live in an area with a higher area deprivation index score. Black RA patients were more likely to have Medicaid as their insurance. Physician prescribing patterns did not vary with area deprivation scores.”

They added, “future studies with larger sample sizes are needed to help quantify the relationships between area deprivation scores and insurance in order to better understand physician prescribing patterns in patients, particularly among minority groups living in these areas, and to understand how these factors may influence disease-related health outcomes in RA and SLE.”