Background Ethnic variation in drug adherence & preference is well documented (1). While usually a reflection of patient autonomy, the issue takes significance if it impedes the provision of effective evidence based care. Indeed, race affects rheumatological disease outcomes (2), likely for both biological & psychosocial reasons. Studies from United States of America found ethnic minorities were less likely to be on a biologic for a rheumatological disease compared to Caucasians, even after adjustment for education & insurance (3). Studies in the United Kingdom found similar results (4), although few investigated the disparity in the acceptance of biologics between ethnicities. Leicester, a midland UK city has an ethnically diverse population, where identifying and addressing such disparities is crucial in delivering effective & equal care.
Objectives To determine any disparity in acceptance of biologic therapy, when offered in person, in a healthcare system free at the point of access, between White British and other ethnicities.
Methods Data was collected from nurse led Biologics therapy clinics, from October 2016 to December 2016. All patients referred were deemed suitable for a biologic as per NICE guidlelines by a Rheumatologist, and were attending the clinic for counselling, assessment & consenting. Proformas were piloted, and improved proformas with information including demographic, disease & treatment details, as well the outcome of the consultation (biologic accepted or rejected) was used to collect data. The collated data were then analysed using EXCEL spread sheet.
Results Data was collected from 55 patients. Interestingly, sex distribution was nearly equal (54% female). 57% of the total sample was White British (WB). The remaining 43% included; Indian, Bangladeshi, Pakistani, White Other, Asian other, African Caribbean & Any other mixed race. The most common disease necessitating referral for a biologic was rheumatoid arthritis (53%).
16% of patients rejected a biologic drug, of which 66% were ethnic minorities. The rejection rate among ethnic minorities was thus 24% compared to 10% in the WB cohort. The highest rejection rate was within the Any Other Mixed Ethnicity cohort (100%), followed by the Bangladeshi cohort (50%). Of note, all patients who rejected biologic therapy from an ethnic minority background did not speak English as their first language. Rejection rates were highest in the Spondyloarthropathies (21%).
Conclusions Our results demonstrate a disparity between the White British population and other ethnicities in the acceptance of biologics, despite one to one counselling. This can have detrimental impacts on treat to target concept and disease progression, and thus will be further investigated & addressed.
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Acknowledgements Administrators & Rheumaotlogy Nurses of University Hospitals of Leicester.
Disclosure of Interest None declared