Racial and Ethnic Disparities in Disease Activity in Rheumatoid Arthritis Patients

Background—Observational studies of patients with rheumatoid arthritis have suggested that racial and ethnic disparities exist for minority populations. We compared disease activity and clinical outcomes across racial and ethnic groups using data from a large, contemporary United States registry. Methods—We analyzed data from two time periods (2005-2007 and 2010-2012). The Clinical Disease Activity Index was examined as both a continuous measure and as dichotomous measures of disease activity states. Outcomes were compared in unadjusted and a series of cross-sectional and longitudinal multivariable regression models. Results—For 2005-2007, significant differences of mean disease activity level (p<0.001) were observed across racial and ethnic groups. Over the five-year period, modest improvements in disease activity were observed across all groups, including whites [3.7 (95% CI 3.2 4.1) compared with African Americans [4.3 (95% CI 2.7 – 5.8)] and Hispanics [2.7 (95% CI 1.2 – 4.3)]. For 2010-2012, significant differences of mean disease activity level persisted (p<0.046) © 2013 Elsevier Inc. All rights reserved. Corresponding Author: Jeffrey D. Greenberg, MD, MPH New York University Hospital for Joint Diseases Department of Rheumatology 301 East 17th Street, suite 1410 New York, NY 10003 Phone: 212.598. 6519 Fax: 212.598. 6582 jeffrey.greenberg@nyumc.org. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conflicts of interest: The CORRONA registry has received financial support unrelated to this study from Abbott, Amgen, AstraZeneca, Eli Lilly, Genentech, Pfizer, UCB and Vertex. Dr. Greenberg receives consulting fees from Astra Zeneca, CORRONA, Novartis and Pfizer, and is a shareholder in CORRONA. Dr. Reed, Dr. Shan and Dr. Harrold have research contracts with CORRONA through the University of Massachusetts. Dr. Kremer is an employee and stockholder of CORRONA, receives consulting fees from Amgen, Abbott, Genetech, and Pfizer, and has research grants from Bristol-Myers Squibb, Genentech, Pfizer, UCB, HGS. Dr. Yazici has received consulting fees from Abbott, BMS, Celgene, Genentech, Merck, Pfizer, Horizon and UCB, as well as research support from BMS, Celgene, Janssen (Centocor) and Genentech. Authorship: All authors had access to the data and played a role in writing this manuscript. NIH Public Access Author Manuscript Am J Med. Author manuscript; available in PMC 2014 December 01. Published in final edited form as: Am J Med. 2013 December ; 126(12): 1089–1098. doi:10.1016/j.amjmed. 2013.09. 002. N IH -P A A uhor M anscript N IH -P A A uhor M anscript N IH -P A A uhor M anscript across racial and ethnic groups, ranging from 11.6 (95% CI 10.4-12.8) in Hispanics to 10.7 (95% CI 9.6-11.7) in whites. Remission rates remained significantly different across racial/ethnic groups across all models for 2010-2012, ranging from 22.7 (95% CI 19.5-25.8) in African Americans to 27.4 (95% CI 24.9-29.8) in whites. Conclusions—Despite improvements in disease activity across racial and ethnic groups over a 5-year period, disparities persist in disease activity and clinical outcomes for minority groups versus white patients.