Session Information
Date: Sunday, November 8, 2015
Title: Health Services Research I: Digital Health and Patient, Provider Factors in Rheumatic Disease
Session Type: ACR Concurrent Abstract Session
Session Time: 2:30PM-4:00PM
Background/Purpose: Prior research has shown that persons
with SLE in poverty have fewer physician visits for SLE and receive lower
technical quality of care. The current study evaluates the impact of poverty at
baseline on longitudinal change in SLE outcomes, including disease activity,
accumulated damage, and overall physical health.
Methods: We analyzed data from the UCSF Lupus Outcomes
Study, a national sample of persons with SLE interviewed annually using a
structured telephone survey. The annual survey collects data to assess whether
individuals are ≤ 125% of the Federal poverty level (POV) as well as validated
self-reported batteries of disease activity, the Systemic Lupus Activity
Questionnaire (SLAQ); accumulated damage, the Brief Index of Lupus Damage
(BILD); and the SF36 physical health component (PCS). We used linear regression
to analyze the impact of POV in the 2012-2013 LOS annual wave on change in
SLAQ, BILD, and PCS between 2012-2013 and 2014-2015. Models were adjusted for age,
gender, race/ethnicity, level of educational attainment; disease duration; number
of physician visits; kind of health care (public and private managed care or
fee-for-service), specialty of physicians for SLE, and quality of care (pass
rate of ≥ 85% on technical quality of care indicators vs. not and summary
of ratings of interactions with providers and health systems).
Results: 524 persons with SLE responded to the annual LOS
interviews in both 2012-2013 and 2014-2015 who had no missing values on
variables in analysis; 10 with missing values were omitted from analysis. Mean
age was 53.0 ± 12.5 yrs., mean duration was 20.1 ± 8.5 yrs., 36.6% were
non-whites, and 12.6% met study definition of POV. In 2012-2013, mean SLAQ was 10.7
± 7.0; BILD 2.9 ± 2.6; and PCS 39.3 ± 12.1. By 2014-2015, mean change in SLAQ
was -0.27 ± 4.21; in BILD was 0.44 ± 0.75; and in PCS was -0.65 ± 7.22. Table 1
shows the unadjusted and adjusted values of the outcome measures by POV and
indicates that poverty is associated with increased levels of BILD, but not
SLAQ or PCS.
Conclusion: Poverty is associated with an increase in
accumulated damage in SLE over two years, an effect only partially explained by
sociodemographic and disease characteristics, number of physician visits, and
kind, quantity, and quality of health care. Reducing the impact of poverty on
damage will require increased attention to factors outside of health care as
well as on-going improvements in treatment.
|
Table 1. Impact of Poverty Status on Change in Disease Activity (SLAQ), Damage (BILD), and Physical Health Status (PCS) |
|||||||||
|
|
Change in SLAQ* |
Change in BILD** |
Change in PCS*** |
||||||
|
|
Not Poor |
Poor |
Diff (95% CI) |
Not Poor |
Poor |
Diff (95% CI) |
Not Poor |
Poor |
Diff (95% CI) |
|
Unadjusted |
-0.24 |
-0.50 |
0.26 (-0.83, 1.36) |
0.40 |
0.73 |
-0.33 (-0.52,- 0.14) |
-0.62 |
-0.90 |
0.29 (-1.58, 2.16) |
|
Adjustedⱡ |
-0.98 |
-1.14 |
0.16 (-1.05, 1.37) |
0.41 |
0.65 |
-0.24 (-0.45, -0.04) |
0.64 |
-0. 01 |
0.65 (-1.40 , 2.70) |
|
* SLAQ scored 0-47, higher scores indicate greater level of disease activity; positive change scores represent more disease activity. |
|||||||||
|
** BILD scored 0-18, higher scores indicate greater level of accumulated damage; positive change scores represent more damage. |
|||||||||
|
*** PCS scored 0-100, higher scores indicate better physical health status; negative change scores represent declining physical health status. |
|||||||||
|
ⱡ Models adjusted for age, gender, race/ethnicity, educational attainment, disease duration, # MD visits in past year, kind of health care, specialty of SLE physicians, technical quality of care pass rate, and ratings of interactions with health systems and providers. |
|||||||||
To cite this abstract in AMA style:
Yelin EH, Trupin L, Yazdany J, Rush S. Poverty Associated with Increase in Damage in SLE over Two-Year Period [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/poverty-associated-with-increase-in-damage-in-sle-over-two-year-period/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/poverty-associated-with-increase-in-damage-in-sle-over-two-year-period/