Background/Purpose:

Racial disparities in systemic lupus erythematosus (SLE) exist, with African-American (AA) patients experiencing higher lupus damage scores and disease activity than white (WH) patients.  Racial differences in SLE patients’ treatment preferences may contribute to these differences and are only partly understood. The goals of the study are to determine whether there are racial differences in willingness to: 1) receive cyclophosphamide (CYC) when physician recommended or 2) participate in a research clinical trial (RCT) involving an experimental medication among SLE patients.  We also seek to determine which demographic, clinical and psychosocial characteristics impact racial differences in either measure of treatment preference.

Methods:

Data from 163 AA and 180 WH SLE patients recruited from two university clinics were evaluated.  Structured interviews and chart reviews were conducted to determine socio-demographic characteristics, clinical factors, perceptions of medications and disease, and beliefs and attitudes towards providers and the healthcare system.  Logistic regression models were performed to evaluate the impact of patient characteristics, including race, on preferences for treatment.

Results:

AAs, compared to WHs, were less likely to have more than a high-school graduate degree (p=0.004), be employed (p=0.024), have higher income (p<0.001), have private insurance (p<0.001) and be married (<0.001).  Among patients who had never received CYC (n=293), 62.9% AAs, compared to 87.6% WHs, were willing to receive the medication (p<0.001).  This difference persisted (OR 0.37 [95% CI, 0.16-0.87]) after adjusting for socio-demographic variables, clinical characteristics, and perceptions about CYC and physicians.  Income ($30,001-50,000 vs. <$10,000, OR 4.07 [95% CI, 1.15-14.33]; >$50,000 vs. <$10,000, OR 4.45 [95% CI, 1.24-15.97]) and higher perception of CYC effectiveness (OR 1.41 [95% CI, 1.25-1.59]) were other significant determinants of willingness to receive CYC in the adjusted model.

Among patients who had never participated in a RCT (n=326), 64.9% AAs, compared to 84.3% WHs were willing to do so (p<0.001).  This difference persisted (OR 0.41 [95% CI, 0.20-0.83]) after adjusting for socio-demographics, clinical variables related to SLE and patients’ perceptions of physicians.  SLE damage index score (4 vs. 0, OR 0.23 [95% CI, 0.07-0.74]), current number of immunosuppressive medications (1 vs. 0, OR 3.65 [95% CI, 1.14-11.73]; ≥2 vs. 0, OR 5.45 [95% CI, 1.62-18.30]) and higher trust in physicians (OR 1.04 [95% CI, 1.00-1.08]) were also independently associated with willingness to participate in a RCT in the adjusted model.

Conclusion:

Variations in lupus patients’ treatment preferences are associated with income, medication history, perceived medication effectiveness and trust in physicians.  Race remains an independent determinant of preferences after adjusting for these variables.  While some factors related to racial differences in patient preferences are relatively fixed, other factors, including medication beliefs and trust in providers, are potentially modifiable and could be addressed to reduce outcome disparities.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/racial-differences-in-systemic-lupus-erythematosus-patients-treatment-preferences-a-two-site-study/