Centre for Rheumatic Disease, Department of Inflammatory Biology.
Psychology Department, Institute for Psychiatry, Psychology & Neuroscience, King's college London.
Rheumatology (Oxford). 2022 Dec 23;62(1):169-180. doi: 10.1093/rheumatology/keac266.
To assess variability in care quality and treatment outcomes across ethnicities in early inflammatory arthritis (EIA).
We conducted an observational cohort study in England and Wales from May 2018 to March 2020, including patients with a suspected/confirmed EIA diagnosis. Care quality was assessed against six metrics defined by national guidelines. Clinical outcomes were measured using DAS28. Outcomes between ethnic groups ('White', 'Black', 'Asian', 'Mixed', 'Other') were compared, and adjusted for confounders.
A total of 35 807 eligible patients were analysed. Of those, 30 643 (85.6%) were White and 5164 (14.6%) were from ethnic minorities: 1035 (2.8%) Black; 2617 (7.3%) Asian; 238 (0.6%) Mixed; 1274 (3.5%) Other. In total, 12 955 patients had confirmed EIA, of whom 11 315 were White and 1640 were from ethnic minorities: 314 (2.4%) Black; 927 (7.1%) Asian; 70 (0.5%) Mixed; 329 (2.5%) Other. A total of 14 803 patients were assessed by rheumatology within three weeks, and 5642 started treatment within six weeks of referral. There were no significant differences by ethnicity. Ethnic minority patients had lower odds of disease remission at three months [adjusted odds ratio 0.79 (95% CI: 0.65, 0.96)] relative to White patients. Ethnic minorities were significantly less likely to receive initial treatment withMTX[0.68 (0.52, 0.90)] or with glucocorticoids [0.63 (0.49, 0.80)].
We demonstrate that some ethnic minorities are less likely to achieve disease remission in three months following EIA diagnosis. This is not explained by delays in referral or time to treatment. Our data highlight the need for investigation into the possible drivers of these inequitable outcomes and reappraisal of EIA management pathways.
评估早期炎症性关节炎（EIA）患者的种族间护理质量和治疗结局的差异。
我们在英格兰和威尔士进行了一项观察性队列研究，研究对象为疑似/确诊 EIA 患者，研究时间为 2018 年 5 月至 2020 年 3 月。护理质量评估基于国家指南定义的六个指标。使用 DAS28 测量临床结局。比较不同种族（“白人”、“黑人”、“亚洲人”、“混合”、“其他”）之间的结局，并对混杂因素进行调整。
共分析了 35807 名合格患者。其中，30643 名（85.6%）为白人，5164 名（14.6%）为少数民族：黑人 1035 名（2.8%）；亚洲人 2617 名（7.3%）；混合 238 名（0.6%）；其他 1274 名（3.5%）。共有 12955 名患者确诊为 EIA，其中 11315 名是白人，1640 名是少数民族：黑人 314 名（2.4%）；亚洲人 927 名（7.1%）；混合 70 名（0.5%）；其他 329 名（2.5%）。共有 14803 名患者在三周内接受了风湿病学评估，5642 名患者在转诊后六周内开始治疗。不同种族间没有显著差异。与白人患者相比，少数民族患者在三个月时达到疾病缓解的可能性较低[调整后的优势比 0.79（95%CI：0.65，0.96）]。少数民族患者初始接受 MTX[0.68（0.52，0.90）]或糖皮质激素治疗的可能性显著降低[0.63（0.49，0.80）]。
我们发现，一些少数民族在 EIA 诊断后三个月内达到疾病缓解的可能性较低。这不是由于转诊或治疗时间延迟造成的。我们的数据突出表明，需要调查造成这些不平等结果的可能驱动因素，并重新评估 EIA 管理途径。
