Racial and Ethnic Disparities in Disease Activity and Function Among Persons With Rheumatoid Arthritis From University-Affiliated Clinics
Racial and Ethnic Disparities in Disease Activity and Function Among Persons With Rheumatoid Arthritis From University-Affiliated Clinics
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DOI：
10.1002/acr.20525
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发表时间：
2011-09-01
影响因子：
4.7
通讯作者：
Yelin, E.
中科院分区：
文献类型：
--
作者：
Barton, J. L.;Trupin, L.;Yelin, E.
Objective.类风湿性关节炎（RA）的健康结果在过去的20年中得到了显着改善。然而，研究表明，种族/族裔和社会经济地位存在差异，对某些弱势群体的研究仍然不足。我们的目的是评估种族/民族的疾病活动和功能的差异，并探讨语言和移民身份的影响，在诊所服务于不同的人群。我们对498例确诊为RA的成人进行了横断面研究，这些患者来自2个风湿病诊所：一个大学医院诊所和一个公立县医院诊所。结果包括28个关节的疾病活动评分（DAS 28）及其组成部分，以及健康评估问卷（HAQ），一种功能测量。我们估计了多变量线性回归模型，包括种族/种族和临床研究中心的相互作用项。在调整年龄、性别、教育、疾病持续时间、类风湿因子状态和药物使用后，按人种/种族、语言和移民状态观察到DAS 28和HAQ评分存在具有临床意义和统计学显著性差异。在大学医院，与非白人相比，白人的疾病活动性较低，功能较好。在大学诊所，按语言（英语与非英语相比）和移民身份（美国出生与移民相比）观察到相同的疾病活动模式。结果在县诊所没有发现显著差异。社会决定因素和类风湿关节炎疾病活动之间的关系在不同的临床环境中有显着差异，在大学中有显着差异，但在县诊所中没有。这些差异可能是在获得专科护理之前发生的事件、依从性差或医疗保健提供系统差异的结果。
Objective. Health outcomes in rheumatoid arthritis (RA) have improved significantly over the past 2 decades. However, research suggests that disparities exist by race/ethnicity and socioeconomic status, with certain vulnerable populations remaining understudied. Our objective was to assess disparities in disease activity and function by race/ethnicity and explore the impact of language and immigrant status at clinics serving diverse populations.Methods. We examined a cross-sectional study of 498 adults with confirmed RA at 2 rheumatology clinics: a university hospital clinic and a public county hospital clinic. Outcomes included the Disease Activity Score in 28 joints (DAS28) and its components, and the Health Assessment Questionnaire (HAQ), a measure of function. We estimated multivariable linear regression models including interaction terms for race/ethnicity and clinic site.Results. After adjusting for age, sex, education, disease duration, rheumatoid factor status, and medication use, clinically meaningful and statistically significant differences in DAS28 and HAQ scores were seen by race/ethnicity, language, and immigrant status. Lower disease activity and better function was observed among whites compared to nonwhites at the university hospital. This same pattern was observed for disease activity by language (English compared to non-English) and immigrant status (US-born compared to immigrant) at the university clinic. No significant differences in outcomes were found at the county clinic.Conclusion. The relationship between social determinants and RA disease activity varied significantly across clinic setting with pronounced variation at the university, but not at the county clinic. These disparities may be a result of events that preceded access to subspecialty care, poor adherence, or health care delivery system differences.