Background/Purpose: Disparities in outcomes among racial/ethnic minorities and individuals with low socioeconomic status with systemic lupus erythematosus (SLE) have been well reported. The degree to which these populations have delayed access to specialists, particularly at the time of diagnosis, is less well described and was the focus of this study.

Methods:  Data were derived from the California Lupus Epidemiology Study (CLUES), a population-based, longitudinal, multi-ethnic cohort of patients with SLE. Data were collected via annual telephone interviews as well as in-person clinical visits. Questions on access to care included time from onset of symptoms to diagnosis of SLE, the specialty of the diagnosing physician, the time until first visit with a specialist (rheumatologist or nephrologist) if not diagnosed by one, and the specialty of the physician currently managing SLE. The significance of the relationships between these variables and race, poverty level, education level and health literacy was determined through chi-squared tests.

Results: This study included 196 patients, with a mean age of 45 (SD 15) years. Thirteen percent had an education level ≤ high school, 34% had limited health literacy and 13% were below 125% of the federal poverty level. The racial/ethnic distribution was 30% Caucasian, 22% Hispanic, 14% African-American and 33% Asian. The time from symptom onset to receiving a diagnosis of SLE varied, with 32% diagnosed in ≤3 months, 22% in 3-6 months, 15% in 6-12 months and 32% in >12 months. There were no significant differences for this outcome by race, education, literacy or poverty level. Of the 84 (43%) patients who received their initial diagnosis from a physician other than a rheumatologist or nephrologist, 64 (76%) were referred to a rheumatologist or nephrologist within 3 months but 20 (24%) experienced a delay >3 months. There was a significant difference in the time to referral to a specialist by race and education level: 64% of African-Americans and 66% of Asians saw a specialist within 3 months of diagnosis, compared with 92% and 85% for Caucasians and Hispanics respectively (p=0.02). For those with an education level ≤ high school, 45% were referred within the first 3 months compared with 81% of those with a higher level of education (p=0.01).

Conclusion:  The time from symptom onset to diagnosis of SLE varied greatly within this population, with up to 32% waiting over 1 year for a diagnosis. Roughly a quarter of SLE patients not initially diagnosed by a rheumatologist or nephrologist experienced a delay in access to specialty care at the time of diagnosis. Of these patients, African-Americans and Asians, as well as those with a lower level of education had the longest delays in accessing specialists.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/disparities-in-access-to-specialist-care-at-the-time-of-diagnosis-of-systemic-lupus-erythematosus/