Initiation of disease-modifying antirheumatic drug therapy in minority and disadvantaged patients with rheumatoid arthritis.

OBJECTIVE: To evaluate disparities in time to initiation of disease modifying antirheumatic drugs (DMARD) in patients with rheumatoid arthritis (RA) receiving care in public or private healthcare settings. METHODS: We reviewed the records of patients with RA initially seen at one of 2 rheumatology clinics: a clinic in a public county hospital providing care primarily to minority, disadvantaged, or uninsured patients, and a private clinic providing care to patients with health insurance coverage. Both clinics were affiliated with the same medical school. We determined time to initiation of DMARD or steroid therapy using Kaplan-Meier analyses and Cox regression. Time to initiation of therapy was measured from onset of disease until a therapy was prescribed (event) or the patient was seen for the first time at one of the 2 clinics (censored at index visit). Independent variables were ethnicity and clinic setting (public or private). RESULTS:One hundred eighteen new patients with RA were seen in the public setting, 167 in the private setting; 83% of the patients in the public clinic and 18% in the private setting were non-White. Survival analysis (disease duration

Keywords:

• Physical therapy
• Private healthcare
• Proportional hazards model
• Survival analysis
• Rheumatology
• Rheumatoid arthritis
• Disease-modifying antirheumatic drug
• Disease
• Medicine
• Diabetes mellitus
• Internal medicine
• Retrospective cohort study
• Cohort study

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