Understanding why rheumatoid arthritis patient treatment preferences differ by race.
Understanding why rheumatoid arthritis patient treatment preferences differ by race.
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DOI：
10.1002/art.24338
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发表时间：
2009-04-15
影响因子：
--
通讯作者：
Fraenkel, Liana
中科院分区：
文献类型：
--
作者：
Constantinescu, Florina;Goucher, Suzanne;Weinstein, Arthur;Smith, Wally;Fraenkel, Liana
风湿性关节炎（RA）患者的偏好可能是不同种族群体之间治疗差异的原因。治疗偏好如何以及为什么会因种族而异还不清楚。我们试图确定黑人和白色RA患者在如何评估与药物相关的特定风险和益处方面是否存在差异。136例RA患者完成了一项联合分析交互式计算机调查，以确定他们如何评估与治疗特征相关的特定风险和获益。我们计算了受访者对每个特征的重要性，以及患者对总体获益与总体风险的重要性比率。风险比小于1的受试者被归类为风险厌恶者。研究样本的平均年龄为55岁（范围22-84岁），49%为黑人，51%为白色。黑人受试者最重视癌症风险，而白色受试者最关心缓解和停止放射学进展的可能性。与12%的白色受试者相比，52%的黑人受试者被发现厌恶风险（p<0.0001）。在调整相关协变量后，种族与风险规避仍然密切相关[调整后的比值比（95%CI）= 8.4（3.1 - 23.1）]。与白色患者相比，黑人患者更重视毒性风险，而不太重视获益的可能性。有效的风险沟通和对预期获益的更好理解可能有助于减少医疗保健中不必要的变化。
Rheumatoid arthritis (RA) patient preferences may account for some of the variability in treatment amongst different racial groups. How and why treatment preferences differ by race is not well understood. We sought to determine whether Black and White RA patients differ in how they evaluate the specific risks and benefits related to medications. 136 RA patients completed a conjoint analysis interactive computer survey to determine how they valued the specific risks and benefits related to treatment characteristics. We calculated the importance that respondents assigned to each characteristic and the ratio of the importance that patients attached to overall benefit versus overall risk. Subjects having a risk ratio of less than one were classified as being risk averse. The mean age of the study sample was 55 years (range 22–84), 49% were Black and 51% were White. Black subjects assigned the greatest importance to the risk of cancer, whereas White subjects were most concerned with the likelihood of remission and halting radiographic progression. Fifty-two percent of Black subjects were found to be risk averse compared to 12% of the White subjects (p<0.0001). Race remained strongly associated with risk aversion [adjusted odds ratio (95% CI) = 8.4 (3.1 – 23.1)] after adjusting for relevant covariates. Black patients attach greater importance to the risks of toxicity and less importance to the likelihood of benefit than their White counterparts. Effective risk communication and improved understanding of expected benefits may help decrease unwanted variability in healthcare.
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