Sun Kai, Eudy Amanda M, Criscione-Schreiber Lisa G, Sadun Rebecca E, Rogers Jennifer L, Doss Jayanth, Corneli Amy L, Bosworth Hayden B, Clowse Megan E B
Department of Medicine, Division of Rheumatology and Immunology, Duke University Medical Center, Durham, USA.
Department of Population Health Sciences and Department of Medicine, Duke University, Durham, USA.
ACR Open Rheumatol. 2020 Jul;2(7):430-437. doi: 10.1002/acr2.11160. Epub 2020 Jun 25.
Medication nonadherence is more common in African Americans compared with Caucasians. We examined the racial adherence gaps among patients with systemic lupus erythematosus (SLE) and explored factors associated with nonadherence.
Cross-sectional data were obtained from consecutive patients prescribed SLE medications seen at an academic lupus clinic between August 2018 and February 2019. Adherence was measured using both self-report and pharmacy refill data. High composite adherence was defined as having both high self-reported adherence and high refill rates. Covariates were patient-provider interaction, patient-reported health status, and clinical factors. We compared adherence rates by race and used race-stratified analyses to identify factors associated with low composite adherence.
Among 121 patients (37% Caucasian, 63% African American), the median age was 44 years (range 22-72), 95% were female, 51% had a college education or more, 46% had private insurance, and 38% had high composite adherence. Those with low composite adherence had higher damage scores, patient-reported disease activity scores, and more acute care visits. High composite adherence rate was lower among African Americans compared with Caucasians (30% vs 51%, P = 0.02), and the gap was largest for those taking mycophenolate (26% vs 75%, P = 0.01). Among African Americans, low composite adherence was associated with perceiving fewer "Compassionate respectful" interactions with providers and worse anxiety and negative affect. In contrast, among Caucasians, low composite adherence was only associated with higher SLE medication regimen burden and fibromyalgia pain score.
Significant racial disparities exist in SLE medication adherence, which likely contributes to racial disparities in SLE outcomes. Interventions may be more effective if tailored by race, such as improving patient-provider interaction and mental health among African Americans.
与白种人相比，非裔美国人的药物治疗依从性较差。我们研究了系统性红斑狼疮（SLE）患者中的种族依从性差距，并探讨了与不依从相关的因素。
横断面数据来自2018年8月至2019年2月在一家学术性狼疮诊所就诊并开具SLE药物的连续患者。使用自我报告和药房配药数据来衡量依从性。高综合依从性定义为自我报告的高依从性和高配药率。协变量包括患者与提供者的互动、患者报告的健康状况和临床因素。我们比较了不同种族的依从率，并使用按种族分层的分析来确定与低综合依从性相关的因素。
在121名患者中（37%为白种人，63%为非裔美国人），中位年龄为44岁（范围22 - 72岁），95%为女性，51%拥有大学及以上学历，46%有私人保险，38%具有高综合依从性。综合依从性低的患者有更高的损伤评分、患者报告的疾病活动评分以及更多的急性护理就诊次数。与白种人相比，非裔美国人的高综合依从率较低（30%对51%，P = 0.02），服用霉酚酸酯的患者差距最大（26%对75%，P = 0.01）。在非裔美国人中，综合依从性低与感觉与提供者的“富有同情心和尊重”的互动较少以及更严重的焦虑和负面情绪有关。相比之下，在白种人中，综合依从性低仅与更高的SLE药物治疗方案负担和纤维肌痛疼痛评分有关。
SLE药物治疗依从性存在显著的种族差异，这可能导致SLE结局的种族差异。如果按种族进行针对性干预，如改善非裔美国人患者与提供者的互动以及心理健康，可能会更有效。
