Movahedi Mohammad, Joshi Raman, Rampakakis Emmanouil, Thorne Carter, Cesta Angela, Sampalis John S, Bombardier Claire
Ontario Best Practices Research Initiative, Toronto General Research Institute University Health Network, Toronto.
JSS Medical Research, St-Laurent, QC.
Medicine (Baltimore). 2019 May;98(20):e15517. doi: 10.1097/MD.0000000000015517.
Access to care and management of Rheumatoid Arthritis (RA) patients may differ based on residential area. We described differences in the profile of patients initiating their first biologic disease modifying antirheumatic drug (bDMARD) based on their residential area type.Cross-sectional analysis of 793 adult RA patients in the longitudinal Ontario Best Practices Research Initiative (OBRI) registry initiating their first bDMARD <30 days prior to or anytime post-enrolment. Patient residential and clinic areas (rural vs. urban) were classified using 2 methods: postal codes and Statistics Canada population centres. Sociodemographics, disease characteristics, and RA medications (tumor necrosis factor inhibitor [TNFi] vs. non-TNFi, concurrent use of conventional synthetic DMARDs [csDMARDs], and intravenous [IV] vs. subcutaneous [SC] bDMARD) at initiation of first bDMARD were contrasted between residential area types.Other than marital status, first language, and race (higher proportion of married, English speaking, Caucasian patients in rural areas), no significant differences were observed in the demographic and disease characteristics of patients living in rural and urban areas. In multivariate analysis, there was no association between residential area type and type of bDMARD use, concurrent csDMARD(s) use or route of bDMARD. However, patients living farther from their treating clinic were significantly less likely to initiate IV bDMARD. Female rheumatologist and rural clinic location were independently associated with lower odds of IV bDMARD use.The use of SC vs. IV bDMARD was associated with being seen in a clinic located in a rural area, being treated by a female rheumatologist, and living farther from treating clinic. These results suggest possible prescription bias in bDMARD selection and/or patient preferences due to convenience.
类风湿关节炎（RA）患者获得的治疗和管理可能因居住地区而异。我们描述了根据居住地区类型，开始使用第一种生物性改善病情抗风湿药物（bDMARD）的患者情况差异。
对安大略省最佳实践研究倡议（OBRI）纵向登记处的793名成年RA患者进行横断面分析，这些患者在入组前30天内或入组后任何时间开始使用第一种bDMARD。患者的居住和诊所地区（农村与城市）使用两种方法进行分类：邮政编码和加拿大统计局人口中心。在开始使用第一种bDMARD时，对比居住地区类型之间的社会人口统计学、疾病特征和RA药物（肿瘤坏死因子抑制剂 [TNFi] 与非TNFi、同时使用传统合成DMARDs [csDMARDs] 以及静脉注射 [IV] 与皮下注射 [SC] bDMARD）。
除婚姻状况、母语和种族外（农村地区已婚、说英语、白种人患者比例较高），农村和城市地区患者的人口统计学和疾病特征未观察到显著差异。在多变量分析中，居住地区类型与bDMARD使用类型、同时使用csDMARD或bDMARD给药途径之间无关联。然而，居住地离治疗诊所较远的患者开始使用静脉注射bDMARD的可能性显著降低。女性风湿病学家和农村诊所位置与静脉注射bDMARD使用几率较低独立相关。
皮下注射与静脉注射bDMARD的使用与在农村地区的诊所就诊、由女性风湿病学家治疗以及居住地离治疗诊所较远有关。这些结果表明，由于便利性，在bDMARD选择中可能存在处方偏见和/或患者偏好。
