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Dr. Suarez-Almazor replies To the Editor: We thank Dr. Solomon, et al for their additional contributions to the very important topic of timely access to therapy for patients with RA from disadvantaged backgrounds. Their study and ours are in very different countries, South Africa and the United States; however, both show a delay in onset of therapy for patients with low socioeconomic status. Our study showed a more marked effect of race in this disparity, which was not observed by Solomon. While the reasons for this discrepancy are not clear, many of our disadvantaged patients in the public County Hospital are Hispanic, often illegal immigrants who in addition, do not speak English. We suspect this may have caused a further delay in seeking care, which we cannot document given the nature of our retrospective review, but could have made the effect of race more prominent than that of healthcare setting alone. Disparities in the provision of healthcare are pervasive, particularly in countries without universal health insurance. We are encouraged to see this issue being assessed by others. The deleterious effects of a delayed onset in treatment are detrimental. Our community of rheumatologists and patient advocates must continue to raise awareness of the need for universal access to therapy for patients with RA. MARIA E. SUAREZ-ALMAZOR, MD, PhD, Barnts Family Distinguished Professor, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 437, Houston, Texas 77030, USA. |
