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Initiation of Disease-Modifying Antirheumatic Drug Therapy in Minority and Disadvantaged Patients with Rheumatoid Arthritis
MARIA E. SUAREZ-ALMAZOR, JAVIER P. BERRIOS-RIVERA, VANESSA COX, NAMIETA M. JANSSEN, DONALD M. MARCUS, and SANDRA SESSOMS
ABSTRACT. Methods. We reviewed the records of patients with RA initially seen at one of 2 rheumatology clinics: a clinic in a public county hospital providing care primarily to minority, disadvantaged, or uninsured patients, and a private clinic providing care to patients with health insurance coverage. Both clinics were affiliated with the same medical school. We determined time to initiation of DMARD or steroid therapy using Kaplan-Meier analyses and Cox regression. Time to initiation of therapy was measured from onset of disease until a therapy was prescribed (event) or the patient was seen for the first time at one of the 2 clinics (censored at index visit). Independent variables were ethnicity and clinic setting (public or private). Results. One hundred eighteen new patients with RA were seen in the public setting, 167 in the private setting; 83% of the patients in the public clinic and 18% in the private setting were non-White. Survival analysis (disease duration ≤ 10 yrs) showed that the median time to initiation of DMARD therapy was 6 years for the public clinic and 1.5 years for the private clinic (p = 0.001), and 7 years for non-White patients, compared to 1 year for White patients (p < 0.0001). For patients with disease duration ≤ 5 years, significant differences were observed for both clinic and ethnicity, with more patients in the private clinic (62%) than in the public clinic (32%) and more White (64%) than non-White (32%) patients having received treatment. Conclusion. These findings suggest that ethnic minorities and uninsured patients are at risk of deleterious outcomes as a consequence of delayed therapeutic onset. (First Release Nov 1 2007; J Rheumatol 2007;34:2400-7) Key Indexing Terms:
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From the Department of General Internal Medicine (Rheumatology), University of Texas MD Anderson Cancer Center, Houston, Texas, USA. Supported by a grant from the National Institute for Arthritis, Musculoskeletal and Skin Disorders (NIAMS), R01 AR47858. Dr. Suarez-Almazor holds a K24 career award from NIAMS, and is the Director of the Houston Center for Education and Research in Therapeutics, funded by the Agency for Health Research and Quality. This study was also partially supported by the Houston Center for Quality of Care and Utilization Studies, Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs. M.E. Suarez-Almazor, MD, PhD, Professor of Medicine; J.P. Berrios-Rivera, MD, Assistant Professor of Medicine, The University of Texas MD Anderson Cancer Center, The University of Texas Health Science Center, Immunology Allergy and Rheumatology, Baylor College of Medicine; V. Cox, MS, Statistician, The University of Texas MD Anderson Cancer Center; D.M. Marcus, MD, Professor of Medicine and Immunology; N.M. Janssen, MD, Associate Professor of Medicine, Immunology Allergy and Rheumatology, Baylor College of Medicine; S. Sessoms, MD, Assistant Professor of Medicine, The Methodist Hospital, Houston. Address reprint requests to Dr. M.E. Suarez-Almazor, Department of General Internal Medicine (Rheumatology), University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., # 437, Houston, TX 77030. E-mail: msalmazor@mdanderson.org Accepted for publication July 17, 2007. |
