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Abstract Number: 557

Differences in Clinical Outcomes in Different Socio-Economic and Racial Groups with Rheumatoid Arthritis: Data from National Inpatient Sample

Dilli Poudel1, Rashmi Dhital2, Abdullateef Abdulkareem3, Pragya Shrestha4 and Paras Karmacharya1, 1Internal Medicine, Reading Health System, WEST READING, PA, 2Universal College of Medical Sciences, MBBS, Kathmandu, Nepal, 3Inernal Medicine, Reading Health System, West Reading, PA, 4Internal medicine, Reading Health System, West Reading, PA

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: morbidity and mortality, race/ethnicity and rheumatoid arthritis (RA)

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Session Information

Date: Sunday, November 13, 2016

Title: Rheumatoid Arthritis – Clinical Aspects - Poster I: Clinical Characteristics/Presentation/Prognosis

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Studies have reported differences in healthcare utilization and outcome among different socioeconomic and ethnic groups. Complications like atherosclerotic cardiovascular diseases (ASCVD) have been documented to be higher among the African-American population and this disparity is more pronounced in the population with connective tissue disease. Similar disparities based on racial/ethnic background have been reported among treatment options for rheumatoid arthritis (RA). We tried to gain an insight into the differences in hospitalization outcomes among RA patients as per different socioeconomic and demographic variables utilizing a large US inpatient database.

Methods: We selected patients aged ≥18 years with and without RA to compare the differences in mortality, length of stay, cost of hospitalization and ASCVD incidence among different race, gender, type of insurance and income quartile range (Table 1). Patients with RA were selected based on ICD-9 codes (714.0, 714.1 and 714.2). Patients with concomitant diagnoses of SLE, polymyositis, dermatomyositis and systemic sclerosis were excluded. We used Nationwide Inpatient Database from 2009 to 2011. STATA version 13.0 (College Station, TX) for analysis to accommodate for the complex design of survey sample data (NIS). NIS is the largest publicly available all-payer inpatient care database in the United States and is sponsored by the Agency for Healthcare Research and Quality as a part of Healthcare Cost and Utilization Project. 

Results: Mortality was most common among Caucasians (RA 2.4%, non-RA 2.37%, p=<0.0001), females (RA 2.67 %, non-RA 2.75%, p=<0.0001) and medicare patients (RA 2.7%, non-RA 3.32%, p=<0.0001). Mortality was lowest in the African American population among RApatients (1.97%, <0.0001) and in hispanics among the non-RA patients (1.58%, <0.0001). Length of stay was highest among the African-American (RA 5.53 days, non-RA 5.27 days, p=<0.0001), females (RA 5.19 days, non-RA 5.22 days, p=<0.0001) and the lowest income quartile (RA 5.27 days, non-RA 4.93 days, p=<0.0001). Patients with the highest income quartile, females and other races incurred the most charges during hospitalization. Incidence of ASCVD was highest among whites (RA 15.08%, non-RA 14.07%, p=<0.0001), females (RA 18.74%, non-RA 17.15%, p=<0.0001) and medicare patients (RA 16.9%, non-RA 19.9%, p=<0.0001).

Conclusion: Our findings indicate differences in clinical outcomes among different socio-economic groups in RA patients. Among patients with RA, we found higher rate of mortality and incidence of ASCVD among Caucasians. Similarly, females were found to have higher incidence of ASCVD, higher length of stay and hospital costs. Socio-economic and racial/ethnic influences may be important in interpreting differences in clinical outcomes relating to patients with RA.

Mortality (%)

Mean LOS (days)

Mean Charge ($)

ASCVD incidence (%)

With RA

Without RA

With RA

Without RA

With RA

Without RA

With RA

Without RA

Caucasian

2.44

2.37

5.13

4.737745

13279.26

12109.85

15.08

14.07

African-American

1.97

1.95

5.53

5.27493

12818.3

11091.65

14.67

12.26

Hispanic

2.07

1.58

5.34

4.409065

14851.72

11232.64

11.85

8.58

Other

2.2

2.19

5.47

4.875703

14941.31

12592.53

13.49

11.53

p-value

<0.0001

<0.0001

<0.0001

<0.0001

<0.0001

<0.0001

<0.0001

<0.0001

Female

2.67

2.75

5.19

5.22

14250.11

13809.57

18.74

17.15

Male

2.17

1.81

5.14

4.44

12922.55

10496.22

13.41

10.32

p-value

<0.0001

<0.0001

0.1023

<0.0001

<0.0001

<0.0001

<0.0001

<0.0001

Medicare

2.7

3.32

5.35

5.48

13202.82

13284.57

16.9

19.9

Medicaid

1.34

1.05

5.38

4.62

12626.63

9458.45

10.06

6.06

Private insurance

1.36

1.24

4.54

3.93

13948.86

11475.32

10

8.08

Self-pay

1.59

1.42

4.73

4.03

10913.64

9232.41

11.57

8.3

No charge

0.68

1.22

5.12

4.71

10560.43

9503.22

9.77

8.12

Other

2.39

2.33

4.59

4.31

13021.86

12081.95

12.63

8.43

p-value

<0.0001

<0.0001

<0.0001

<0.0001

<0.0001

<0.0001

<0.0001

<0.0001

Income Quartile 1±

2.28

2.27

5.27

4.93

12123.11

10865.25

14.6

13.21

Quartile 2±

2.28

2.18

5.07

4.67

12942.07

11573.12

14.91

13.26

Quartile 3±

2.26

2.12

5.09

4.64

13735.14

12248.06

15.22

13.16

Quartile 4±

2.39

2.18

5.15

4.64

14696.85

13154.86

14.42

12.83

p-value

0.5656

<0.0001

0.0001

<0.0001

<0.0001

<0.0001

0.0326

0.1064

  Table 1: Distribution of mortality, mean length of stay, mean hospital charge and ASCVD incidence by race, gender, type of insurance and income quartile range. ± For year 2011:  Quartile 1 (1 – 38,999); Quartile 2 (39,000 – 47,999); Quartile 3 (48,000 – 63,999); Quartile 4 (64,000+)


Disclosure: D. Poudel, None; R. Dhital, None; A. Abdulkareem, None; P. Shrestha, None; P. Karmacharya, None.

To cite this abstract in AMA style:

Poudel D, Dhital R, Abdulkareem A, Shrestha P, Karmacharya P. Differences in Clinical Outcomes in Different Socio-Economic and Racial Groups with Rheumatoid Arthritis: Data from National Inpatient Sample [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/differences-in-clinical-outcomes-in-different-socio-economic-and-racial-groups-with-rheumatoid-arthritis-data-from-national-inpatient-sample/. Accessed .
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