Background/Purpose: The use of biologic DMARDs for RA has improved outcomes, but it is unknown whether there are disparities in initiation of these agents by sociodemographic, medical, health system, and community characteristics.

Methods: We analyzed data from the UCSF Rheumatoid Arthritis Panel for the years 1999 through 2011. Panel participants are drawn from a random sample of Northern California rheumatologists, with enrollments in 1982/1983, 1985, 1989, 1999, and 2003. Principal data collection is by a structured annual phone survey. We used Cox regression to estimate the effect of individual- and community-level characteristics on the first initiation of a biological DMARD.  Individual-level characteristics include sociodemographics (age, gender, race, ethnicity, marital status, formal education, annual household income), medical (HAQ, # painful and # swollen joints and # comorbid conditions, Geriatic Depression Score, and use of oral steroids, non-biological DMARDs, and NSAIDS), and health system (having any health insurance, including for medications; HMOs vs. fee-for-service; and # of rheumatologist visits in prior year). Community-level characteristics include # of rheumatologists per capita, presence of a federally qualified health center in local area, and living in area of concentrated poverty.

Results: 527 persons were in the RA Panel in 1999. 83% were female, 83% whites, 7% Hispanics, 41% ≤ high school, and 38% had household income < 30,000/year. Mean (Std) age was 61 (14), RA duration was 20 (11) years, and HAQ score was 1.1 (0.7).  Among the 527 persons, 20% had initiated biological therapy by 2000, 40% by 2005, and 43% by 2011. In fully adjusted Cox regression models that include all medical characteristics, younger age [Hazard Ratio (HR) for ages 19-54 =1.89 (95%CI 1.24, 2.87); HR for 55-69=1.25 (0.84,1.87)], Hispanic ethnicity [HR 2.02 (1.05, 3.86], household incomes >$30,000/year [HR1.61 (1.12, 2.32)], being married or with a partner [HR 1.39 (1.00, 1.92)], and living in a rural setting [HR 1.96 (1.28, 2.99)] were associated with a higher probability of initiating a biologic DMARD.  The following characteristics were associated with a lower probability: having no [HR 0.18 (0.08, 0.40)] or only 1-4 rheumatology visits in the year prior to interview [HR 0.60 (0.45, 0.81)] and living in an area with Federally qualified health centers [HR 0.63 (0.41, 0.96)]. After adjustment, no medical characteristics were associated with initiation of a biologic DMARD.

Conclusion: These results indicate that many sociodemographic and community characteristics influence the initiation of biologic DMARDs, suggesting attention to these characteristics to improve access to such treatment.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/sociodemographic-health-system-and-community-characteristics-associated-with-initiation-of-biological-dmards-in-ra/