Background/Purpose: Ethnic disparities in the administration of DMARDs exist, but the impact of differing health care systems on access in ethnic minorities treated by rheumatologists, is unknown. The Veterans Affairs RA (VARA) registry and Ethnic Minority RA Consortium (EMRAC) are prospective databases but, EMRAC patients receive RA therapies primarily through private insurance/Medicare/Medicaid coverage, while VA patients have unrestricted access. We compared these cohorts to evaluate the role of medication access in RA treatment discrepancies.

Methods: Both registries collect demographic data, RA disease severity (nodules, erosions, RF, ACPA), and activity (MDHAQ, pain, patient/MD global scores, TJC, SJC, ESR, CRP, CDAI, DAS28 and RAPID3) measures. To establish comparability between registries, equivalence tests were estimated for demographic, clinical, disease activity measures. To estimate differences in prednisone, DMARD, biologic use between health care systems, Chi-square tests of independence were used. Both equivalence tests and medication use differences between ethnic groups (Caucasians vs non-Caucasians) were examined. Finally, multivariable logistic regression was used to estimate differences in biologic use between race and health care systems adjusting for age, education, disease duration, and RAPID3.

Results: 1959 VARA and EMRAC 1083 patients were analyzed. Both cohorts had equivalent age, education and RAPID3 scores, but lacked equivalency for disease duration (VARA 13.5 + 12.2, EMRAC 10.2 +10.2 years) and MD global scores (VARA 2.0 + 2.6, EMRAC 3.1 + 2.3). VARA had more males (91%, EMRAC 15%) and Caucasians (77%, EMRAC 42%) . Prednisone and DMARD use were more frequent in VARA patients (38% vs 31%, p<0.001; 71% vs 66%, p=0.006, respectively). Biologic use was reported in 422 (22%) of VARA subjects (Caucasian 21%, non-Caucasian 22%), lower than in the 391 (36%) EMRAC subjects (Caucasian 45%, non-Caucasian 33%, (P<0.001). While there was no difference in biologic use between non-Caucasians in each cohort (non-Caucasian 28% vs Caucasian 26%, p=0.285), there was interaction between ethnicity and health care systems. Caucasian EMRAC subjects had a 60% increased odds of biologic use vs non-Caucasian subjects regardless of health care system (OR=1.59, P=0.007), and a 47% increased odds compared to Caucasian VARA subjects (OR=1.5, P=0.024), adjusting for age, education, disease duration and RAPID3 score. Biologic use was not different between other ethnicity and health care system comparisons. Because of the inter-dependency between gender prevalence and health care system, gender could not be modeled in the logistic regression.

Conclusion: Comparisons of two different health care administrative systems suggest non-Caucasian RA patients with unrestricted access to treatment do not achieve similar frequency of biologic use as Caucasian patients with insurance coverage, despite comparable disease activity. However, there is no difference in biologic use amongst ethnic minorities between health care systems. Reasons for these findings require further evaluation in order to accurately assess RA treatment outcomes in diverse ethnic populations.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/disparity-in-biologic-therapy-in-ethnic-minorities-with-rheumatoid-arthritis-can-it-all-be-due-to-lack-of-access-to-drug/