Peterman Nicholas J, Vashi Aksal, Govan Devan, Bhatia Amrit, Vashi Tejal, Kaptur Brad, Yeo Eunhae G, Gizinski Alison
Medicine, Carle Foundation Hospital, Urbana, USA.
Medicine, Carle Illinois College of Medicine, Urbana, USA.
Cureus. 2022 Jun 30;14(6):e26448. doi: 10.7759/cureus.26448. eCollection 2022 Jun.
The American College of Rheumatology guidelines provides a strong recommendation for the use of biologic disease-modifying antirheumatic drugs (bDMARDs) when conventional rheumatoid arthritis treatments fail to meet treatment targets. Although bDMARDs are an effective and important treatment component, access inequalities remain a challenge in many communities worldwide. The purpose of this analysis is to assess nationwide trends in bDMARD access in the United States, with a specific focus on rural and urban access gaps. This study combined multiple county-level databases to assess bDMARD prescriptions from 2015 to 2019. Using geospatial analysis and the Moran's I statistic, counties were classified according to prescription levels to assess for hotspots and coldspots. Analysis of variance (ANOVA) was used to compare significant counties across 49 socioeconomic variables of interest. The analysis identified statistically significant hotspot and coldspot prescription clusters within the United States. Coldspot (Low-Low) clusters with low access to bDMARDs are located predominantly in the rural west North Central region, extending down to Oklahoma and Arkansas. Hotspot (High-High) clusters are seen in urban and metro areas of Wisconsin, Minnesota, Pennsylvania, North Carolina, Georgia, Oregon, and the southern tip of Texas. Comparing coldspot to hotspot areas of bDMARD access revealed that the Medicare populations were older, more rural, less educated, less impoverished, and less likely to get their bDMARDs from a rheumatologist.
美国风湿病学会指南强烈建议，当传统的类风湿性关节炎治疗无法达到治疗目标时，使用生物改善病情抗风湿药（bDMARDs）。尽管bDMARDs是一种有效且重要的治疗药物，但在全球许多社区，获取药物方面的不平等现象仍然是一个挑战。本分析的目的是评估美国全国范围内bDMARDs获取情况的趋势，特别关注农村和城市之间的获取差距。本研究整合了多个县级数据库，以评估2015年至2019年期间bDMARDs的处方情况。利用地理空间分析和莫兰指数统计，根据处方水平对各县进行分类，以评估热点和冷点。方差分析（ANOVA）用于比较49个感兴趣的社会经济变量中的显著县。分析确定了美国境内具有统计学意义的热点和冷点处方集群。bDMARDs获取率低的冷点（低-低）集群主要位于中西部偏北的农村地区，一直延伸到俄克拉荷马州和阿肯色州。热点（高-高）集群出现在威斯康星州、明尼苏达州、宾夕法尼亚州、北卡罗来纳州、佐治亚州、俄勒冈州的城市和大都市地区，以及得克萨斯州的南端。比较bDMARDs获取的冷点和热点地区发现，医疗保险人群年龄更大、居住在农村地区的比例更高、受教育程度更低、贫困程度更低，而且从风湿病专家那里获得bDMARDs的可能性更小。
