C.Y. Lane, PT, DPT, L.M. Thoma, PT, DPT, PhD, Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;
D. Lo, ScM, T. Zhang, MD, PhD, H. Varma, MS, D.S. Dalal, MD, MPH, T.I. Shireman, PhD, Department of Health Services, Policy and Practices, Brown University School of Public Health, Providence, Rhode Island.
J Rheumatol. 2023 Nov;50(11):1414-1421. doi: 10.3899/jrheum.2023-0103. Epub 2023 Aug 1.
To examine influences of sociocultural and economic determinants on physical therapy (PT) utilization for older adults with rheumatoid arthritis (RA).
In these annual cross-sectional analyses between 2012 and 2016, we accessed Medicare enrollment data and fee-for-service claims. The cohort included Medicare beneficiaries with RA based on 3 diagnosis codes or 2 codes plus a disease-modifying antirheumatic drug medication claim. We defined race and ethnicity and dual Medicare/Medicaid coverage (proxy for income) using enrollment data. Adults with a Current Procedural Terminology code for PT evaluation were classified as utilizing PT services. Associations between race and ethnicity and dual coverage and PT utilization were estimated with logistic regression analyses. Potential interactions between race and ethnicity status and dual coverage were tested using interaction terms.
Of 106,470 adults with RA (75.1% female; aged 75.8 [SD 7.3] years; 83.9% identified as non-Hispanic White, 8.8% as non-Hispanic Black, 7.2% as Hispanic), 9.6-12.5% used PT in a given year. Non-Hispanic Black (adjusted odds ratio [aOR] 0.77, 95% CI 0.73-0.82) and Hispanic (aOR 0.92, 95% CI 0.87-0.98) individuals had lower odds of PT utilization than non-Hispanic White individuals. Adults with dual coverage (lower income) had lower odds of utilization than adults with Medicare only (aOR 0.44, 95% CI 0.43-0.46). There were no significant interactions between race and ethnicity status and dual coverage on utilization.
We found sociocultural and economic disparities in PT utilization in older adults with RA. We must identify and address the underlying factors that influence these disparities in order to mitigate them.
探讨社会文化和经济决定因素对老年类风湿关节炎患者物理治疗（PT）利用的影响。
在 2012 年至 2016 年的这些年度横断面分析中，我们访问了医疗保险登记数据和按服务收费的索赔。队列包括基于 3 个诊断代码或 2 个代码加 1 种疾病修饰抗风湿药物药物索赔的类风湿关节炎医疗保险受益人的数据。我们使用登记数据定义种族和民族以及双重医疗保险/医疗补助覆盖（收入代理）。具有物理治疗评估的当前程序术语代码的成年人被归类为使用物理治疗服务。使用逻辑回归分析估计种族和民族以及双重覆盖与物理治疗利用之间的关联。使用交互项测试种族和民族地位与双重覆盖之间的潜在交互作用。
在 106470 名患有 RA 的成年人中（75.1%为女性；年龄 75.8[7.3]岁；83.9%为非西班牙裔白人，8.8%为非西班牙裔黑人，7.2%为西班牙裔），每年有 9.6%-12.5%的人使用 PT。非西班牙裔黑人（调整后的优势比[aOR]0.77，95%CI0.73-0.82）和西班牙裔（aOR0.92，95%CI0.87-0.98）个体接受 PT 的可能性低于非西班牙裔白人。与仅接受医疗保险的成年人相比，具有双重覆盖（低收入）的成年人接受治疗的可能性较低（aOR0.44，95%CI0.43-0.46）。在利用方面，种族和民族地位与双重覆盖之间没有显著的相互作用。
我们发现老年类风湿关节炎患者在接受 PT 治疗方面存在社会文化和经济差异。我们必须确定和解决影响这些差异的根本原因，以减轻这些差异。
