African American and Hispanic rheumatoid arthritis patients treated at public clinics wait longer to start disease-modifying antirheumatic drug therapy than do their white counterparts receiving care at private clinics.
Early intervention with DMARDs has been shown to delay joint damage.
Dr. Maria E. Suarez-Almazor, rheumatology section chief at the University of Texas M.D. Anderson Cancer Center, Houston, reported data from her retrospective cohort study of all medical records of new patients with a rheumatoid arthritis diagnosis seen at a public clinic (n=118) and a private clinic (n=167).
Both facilities are affiliated with the Baylor College of Medicine, Houston, staffed by Baylor rheumatology fellows and faculty, and considered tertiary-level care facilities. The public clinic cares for mostly minority, disadvantaged, or uninsured patients. Most of the private clinic patients had private insurance.
Socioeconomic status was inferred from insurance status and attendance at the public or private clinic, an admittedly imperfect method. Patients were classified as white, African American, Hispanic, or other. Nonwhites accounted for 83% of the patients seen in the public clinic versus 18% in the private clinic, a highly significant statistical difference.
The median time to initiation of DMARDs was 7 years for public clinic patients and 3 years for private clinic patients. The median time to initiation of steroids was 23 years for public patients and 1 year for private patients. And in all patients at both clinics, the median time to initiation of DMARDs for white patients was 3 years, versus 7 years for nonwhites (J. Rheumatol. 2007 Nov. 1 [Epub ahead of print]).
In an interview, Dr. Suarez-Almazor questioned whether the disparity is related to a communication problem between patients and doctors, such that physicians are unable to communicate the importance of expensive DMARDs.
She reported no conflicts of interest in relation to this study.