Background/Purpose: Chinese-Americans are a fast growing US immigrant group, and many use Traditional Chinese Medicine (TCM). Ethnic Chinese patients also have worse outcomes in SLE and RA compared to Caucasians. In order to optimally care for this growing population with rheumatic diseases, rheumatologists must have some understanding of patients’ traditional cultural beliefs and practices, which may influence medication taking behaviors, and thus ultimately outcomes. TCM use by Chinese-American rheumatology patients has not previously been studied, and whether patient-reported outcomes differ between TCM users and nonusers is unknown.

Methods: Subjects were recruited from two rheumatology clinics that serve a predominantly Chinese-American immigrant population. Inclusion criteria were English or Mandarin Chinese fluency and being actively treated for a systemic rheumatic disease. Questionnaires were used to assess TCM use, acculturation, and demographics. Self-reported health status was assessed using Patient-Reported Outcome Measurement Information System (PROMIS®) short forms. Chart review was performed to gather clinical data. Parametric and nonparametric statistics were performed as appropriate. Multivariable logistic regression using step-wise selection was used to examine factors independently associated with TCM use.

Results: 230 enrolled, median age 55 years (range 20-97), 65% female, 71% ≤ high school education, 70% Medicaid, and 22% reported English fluency. 50% reported TCM use in the past year, most frequently tuina massage (47%), acupuncture (45%), and herbs (37%). 60% of TCM users used TCM to treat rheumatic disease, but only 34% discussed TCM use with the rheumatologist. TCM users had worse scores in PROMIS® anxiety, depression, pain interference, fatigue, physical function, and social health. There was no difference in PROMIS® scores between herb users and nonusers; however more frequent TCM users and those using TCM to treat rheumatic disease had worse pain and function. In multivariable analysis, older age (Odds Ratio [OR]1.03, p=0.04), female sex (OR 2.3, p=0.02), ≥ some college education (OR 2.1, p=0.04), US residence for ≥20 years (OR 2.2, p=0.03), more anxiety (OR 1.05, p=0.004), fewer years since rheumatic disease diagnosis (OR 1.1, p=0.01), reporting western medicine to be ineffective (OR 5.3, p=0.003), and belief in TCM (OR 2.8, p=0.01) were independently associated with TCM use.

Conclusion: In this group of Chinese-American rheumatology patients with low education, low socioeconomic status, and poor acculturation, TCM use is common (50%) and is independently associated with older age, female sex, better education, longer US residence, higher levels of anxiety, more recent rheumatic disease diagnosis, perceived ineffectiveness of western medicine, and stronger belief in TCM. Providers should ask Chinese-American patients about TCM use because it may be a proxy for unmet therapeutic needs in this population, as TCM users have worse patient-reported outcomes across many important domains.

« Back to 2017 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/chinese-american-rheumatology-patients-who-use-traditional-chinese-medicine-have-worse-patient-reported-outcomes/