Clinical research study
Racial and Ethnic Disparities in Disease Activity in Patients with Rheumatoid Arthritis

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Abstract

Background

Observational studies of patients with rheumatoid arthritis have suggested that racial and ethnic disparities exist for minority populations. We compared disease activity and clinical outcomes across racial and ethnic groups using data from a large, contemporary US registry.

Methods

We analyzed data from 2 time periods (2005-2007 and 2010-2012). The Clinical Disease Activity Index was examined as both a continuous measure and a dichotomous measure of disease activity states. Outcomes were compared in a series of cross-sectional and longitudinal multivariable regression models.

Results

For 2005-2007, significant differences of mean disease activity level (P < .001) were observed across racial and ethnic groups. Over the 5-year period, modest improvements in disease activity were observed across all groups, including whites (3.7; 95% confidence interval [CI], 3.2-4.1) compared with African Americans (4.3; 95% CI, 2.7-5.8) and Hispanics (2.7; 95% CI, 1.2-4.3). For 2010-2012, significant differences of mean disease activity level persisted (P < .046) across racial and ethnic groups, ranging from 11.6 (95% CI, 10.4-12.8) in Hispanics to 10.7 (95% CI, 9.6-11.7) in whites. Remission rates remained significantly different across racial/ethnic groups across all models for 2010-2012, ranging from 22.7 (95% CI, 19.5-25.8) in African Americans to 27.4 (95% CI, 24.9-29.8) in whites.

Conclusions

Despite improvements in disease activity across racial and ethnic groups over a 5-year period, disparities persist in disease activity and clinical outcomes for minority groups versus white patients.

Section snippets

Data Source

The CORRONA registry is a longitudinal observational cohort study of patients with rheumatoid arthritis or psoriatic arthritis who are enrolled by participating rheumatologists in both community-based and academic clinical sites; the details have been published.13, 14 Over the study period, a total of 112 community-based practices and 32 academic practices contributed patient data to the registry. Approvals for data collection and analyses were obtained for academic and community-based practice

Demographic and Clinical Characteristics

Baseline demographic and clinical characteristics of the 2 study cohorts are summarized in Table 1. For both the 2005-2007 and 2010-2012 cohorts, the majority of the patients were female, with a higher proportion of female patients for African Americans, Hispanics, and Asians versus white patients. In both cohorts, the mean age was approximately 60 years, although white patients were slightly older than the other racial/ethnic groups in both time periods. The majority of patients with

Discussion

In this study, we observed significant racial and ethnic variation in disease activity in a large US-based cohort of patients with rheumatoid arthritis. We also observed differences in functional status across racial and ethnic groups. In comparisons of minority groups versus white patients in both time periods, we observed that Hispanic patients had higher disease activity levels, whereas African American patients achieved lower rates of clinical remission. For both time periods, African

Conclusions

Despite the continued growth of newly approved disease-modifying antirheumatic drug options and the publication of recommendations for standardized disease activity monitoring and treatment strategies, our study indicates that racial and ethnic disparities continue to exist across a network of US-based rheumatology practices. Interventions to address these disparities for minority patients with rheumatoid arthritis are needed to improve clinical outcomes.

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  • Cited by (0)

    Funding: JDG was supported by grants from the National Institutes of Health (NIH)/National Institute of Arthritis and Musculoskeletal and Skin Diseases (K23 AR054412) and the NIH/National Center for Research Resources (5UL1RR029893). LRH has received support from the NIH (AR053856).

    Conflict of Interest: The Consortium of Rheumatology Researchers of North America (CORRONA) registry has received financial support unrelated to this study from Abbott, Amgen, AstraZeneca, Eli Lilly, Genentech, Pfizer, UCB, and Vertex. JDG receives consulting fees from AstraZeneca, CORRONA, Novartis, and Pfizer, and is a shareholder in CORRONA. YS, GR, and LRH have research contracts with CORRONA through the University of Massachusetts. JMK is an employee and stockholder of CORRONA; receives consulting fees from Amgen, Abbott, Genetech, and Pfizer; and has research grants from Bristol-Myers Squibb, Genentech, Pfizer, UCB, and HGS. YY has received consulting fees from Abbott, BMS, Celgene, Genentech, Merck, Pfizer, Horizon, and UCB, and research support from BMS, Celgene, Janssen (Centocor), and Genentech.

    Authorship: All authors had access to the data and played a role in writing this manuscript.

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