Suarez-Almazor Maria E, Berrios-Rivera Javier P, Cox Vanessa, Janssen Namieta M, Marcus Donald M, Sessoms Sandra
Department of General Internal Medicine (Rheumatology), University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
J Rheumatol. 2007 Dec;34(12):2400-7. Epub 2007 Nov 1.
To evaluate disparities in time to initiation of disease modifying antirheumatic drugs (DMARD) in patients with rheumatoid arthritis (RA) receiving care in public or private healthcare settings.
We reviewed the records of patients with RA initially seen at one of 2 rheumatology clinics: a clinic in a public county hospital providing care primarily to minority, disadvantaged, or uninsured patients, and a private clinic providing care to patients with health insurance coverage. Both clinics were affiliated with the same medical school. We determined time to initiation of DMARD or steroid therapy using Kaplan-Meier analyses and Cox regression. Time to initiation of therapy was measured from onset of disease until a therapy was prescribed (event) or the patient was seen for the first time at one of the 2 clinics (censored at index visit). Independent variables were ethnicity and clinic setting (public or private).
One hundred eighteen new patients with RA were seen in the public setting, 167 in the private setting; 83% of the patients in the public clinic and 18% in the private setting were non-White. Survival analysis (disease duration <or= 10 yrs) showed that the median time to initiation of DMARD therapy was 6 years for the public clinic and 1.5 years for the private clinic (p = 0.001), and 7 years for non-White patients, compared to 1 year for White patients (p < 0.0001). For patients with disease duration <or= 5 years, significant differences were observed for both clinic and ethnicity, with more patients in the private clinic (62%) than in the public clinic (32%) and more White (64%) than non-White (32%) patients having received treatment.
These findings suggest that ethnic minorities and uninsured patients are at risk of deleterious outcomes as a consequence of delayed therapeutic onset.
评估在公立或私立医疗机构接受治疗的类风湿关节炎（RA）患者中，启动改善病情抗风湿药物（DMARD）治疗的时间差异。
我们回顾了最初在两家风湿病诊所之一就诊的RA患者记录：一家位于公立县医院的诊所，主要为少数族裔、弱势或未参保患者提供治疗；另一家私立诊所则为有医疗保险的患者提供治疗。两家诊所均隶属于同一所医学院。我们使用Kaplan-Meier分析和Cox回归确定启动DMARD或类固醇治疗的时间。治疗启动时间从疾病发作开始计算，直至开出治疗处方（事件）或患者首次在两家诊所之一就诊（在首次就诊时截尾）。自变量为种族和诊所类型（公立或私立）。
在公立诊所就诊的新RA患者有118例，私立诊所为167例；公立诊所83%的患者和私立诊所18%的患者为非白人。生存分析（疾病持续时间≤10年）显示，公立诊所启动DMARD治疗的中位时间为6年，私立诊所为1.5年（p = 0.001）；非白人患者为7年，白人患者为1年（p < 0.0001）。对于疾病持续时间≤5年的患者，诊所类型和种族方面均观察到显著差异，私立诊所接受治疗的患者（62%）多于公立诊所（32%），白人患者（64%）多于非白人患者（32%）。
这些发现表明，少数族裔和未参保患者因治疗启动延迟而面临有害后果的风险。
