Racial and ethnic disparities in disease activity and function among persons with rheumatoid arthritis from university-affiliated clinics

Jennifer Barton, L. Trupin, D. Schillinger, S. A. Gansky, C. Tonner, M. Margaretten, V. Chernitskiy, J. Graf, J. Imboden, E. Yelin

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1238-1246
Number of pages9
JournalArthritis Care and Research
Volume63
Issue number9
DOIs
StatePublished - Sep 2011
Externally publishedYes

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Rheumatoid Arthritis
Language
Linear Models
Health
Joints
Delivery of Health Care
County Hospitals
Sex Education
Rheumatoid Factor
Public Hospitals
Rheumatology
Vulnerable Populations
Social Class
Cross-Sectional Studies
Research
Population

ASJC Scopus subject areas

  • Rheumatology

Cite this

Racial and ethnic disparities in disease activity and function among persons with rheumatoid arthritis from university-affiliated clinics. / Barton, Jennifer; Trupin, L.; Schillinger, D.; Gansky, S. A.; Tonner, C.; Margaretten, M.; Chernitskiy, V.; Graf, J.; Imboden, J.; Yelin, E.

In: Arthritis Care and Research, Vol. 63, No. 9, 09.2011, p. 1238-1246.

Research output: Contribution to journalArticle

Barton, J, Trupin, L, Schillinger, D, Gansky, SA, Tonner, C, Margaretten, M, Chernitskiy, V, Graf, J, Imboden, J & Yelin, E 2011, 'Racial and ethnic disparities in disease activity and function among persons with rheumatoid arthritis from university-affiliated clinics', Arthritis Care and Research, vol. 63, no. 9, pp. 1238-1246. https://doi.org/10.1002/acr.20525
Barton, Jennifer ; Trupin, L. ; Schillinger, D. ; Gansky, S. A. ; Tonner, C. ; Margaretten, M. ; Chernitskiy, V. ; Graf, J. ; Imboden, J. ; Yelin, E. / Racial and ethnic disparities in disease activity and function among persons with rheumatoid arthritis from university-affiliated clinics. In: Arthritis Care and Research. 2011 ; Vol. 63, No. 9. pp. 1238-1246.
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N2 - 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.

AB - 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.

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