Sociodemographic, Disease, Health System, and Contextual Factors Affecting the Initiation of Biologic Agents in Rheumatoid Arthritis: A Longitudinal Study
Open Access
- 10 December 2013
- journal article
- research article
- Published by Wiley in Arthritis Care & Research
- Vol. 66 (7), 980-989
- https://doi.org/10.1002/acr.22244
Abstract
Objective To analyze the effect of sociodemographic, disease, and health system characteristics and contextual features about the community of residence on the subsequent initiation of treatment with biologic agents for rheumatoid arthritis (RA). Methods We analyzed data from the University of California, San Francisco Rheumatoid Arthritis Panel Study for the years 1999–2011. Principal data collection was by a structured annual phone survey. We estimated Kaplan‐Meier curves of the time until initiation of biologic agents, stratified by age and income. We also used Cox regression to estimate the effect of individual‐level sociodemographic and medical factors, contextual‐level socioeconomic status measures, and density of health providers in the local community on the probability of initiating therapy with biologic agents for RA. Results In total, 527 persons were included in the panel in 1999, and 229 persons (44%) had initiated therapy with biologic agents by 2011. In multivariable Cox regression models, age <70 years (hazard ratio [HR] for ages 19–54 years 1.89 [95% confidence interval (95% CI) 1.24–2.87] and HR for ages 55–69 years 1.25 [95% CI 0.84–1.87]), Hispanic ethnicity (HR 2.02 [95% CI 1.05–3.86]), household income ≥$30,000/year (HR 1.61 [95% CI 1.12–2.32]), being married or with a partner (HR 1.39 [95% CI 1.00–1.92]), and residence in rural environments (HR 1.96 [95% CI 1.28–2.99]) were associated with a higher probability of initiating biologic agents. Having no (HR 0.18 [95% CI 0.08–0.40]) or only 1–4 rheumatology visits in the year prior to interview (HR 0.60 [95% CI 0.45–0.81]) and living in an area with ≥1 federally qualified health centers (HR 0.63 [95% CI 0.41–0.96]) were associated with a lower probability. Conclusion The probability of initiating therapy with biologic agents is affected by sociodemographic and health system characteristics as well as the nature of the community of residence, resulting in disparities in access to these medications.Funding Information
- NIH (R01-AR-056215, K23-AR-059677, K24-AR-055989, and P60-AR-047782)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases
- Multidisciplinary Clinical Research Center (P60-A-053308)
- Amgen
- Agency for Healthcare Research and Quality
- National Institute on Aging (R01-AG-023178, R01-AG-042845)
- Patient-Centered Outcomes Research Institute (funding announcement 12001)
This publication has 23 references indexed in Scilit:
- 2012 Update of the 2008 American College of Rheumatology recommendations for the use of disease‐modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritisArthritis Care & Research, 2012
- Decision tool to improve the quality of care in rheumatoid arthritisArthritis Care & Research, 2012
- Use of disease‐modifying medications for rheumatoid arthritis by race and ethnicity in the National Ambulatory Medical Care SurveyArthritis Care & Research, 2011
- Dropping the Baton: Specialty Referrals in the United StatesThe Milbank Quarterly, 2011
- Receipt of Disease-Modifying Antirheumatic Drugs Among Patients With Rheumatoid Arthritis in Medicare Managed Care PlansJAMA, 2011
- Patient‐physician discordance in assessments of global disease severity in rheumatoid arthritisArthritis Care & Research, 2010
- American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease‐modifying antirheumatic drugs in rheumatoid arthritisArthritis Care & Research, 2008
- Treatment of older adult patients diagnosed with rheumatoid arthritis: Improved but not optimalArthritis Care & Research, 2007
- Benefit Design And Specialty Drug UseHealth Affairs, 2006
- A Comparison of the Treatment of Rheumatoid Arthritis in Health Maintenance Organizations and Fee-for-Service PracticesThe New England Journal of Medicine, 1985