title: Association of socioeconomic and demographic factors with utilization of rheumatology subspecialty care in systemic lupus erythematosus.
abstract: OBJECTIVE
  To examine the role of sociodemographic factors (age, race/ethnicity, and sex) and socioeconomic factors (income and education) in the utilization of rheumatology subspecialty care in a large cohort of subjects with systemic lupus erythematosus (SLE).
  
  
  METHODS
  Data were derived from a cohort of 982 English-speaking subjects with SLE. Between 2002 and 2004, trained survey workers administered a telephone survey to subjects eliciting information regarding demographics, SLE disease status, medications, health care utilization, health insurance, and socioeconomic status. We identified predictors of utilization of rheumatology subspecialty care, defined as at least 1 visit to a rheumatologist in the previous year. In addition, we examined factors associated with identifying any specialist as primarily responsible for SLE care.
  
  
  RESULTS
  Older age, lower income, Medicare insurance, male sex, and less severe disease were associated with lack of rheumatology care. However, race/ethnicity and educational attainment were not significantly related to seeing a rheumatologist. After multivariate adjustment, only older age, lower income, and male sex remained associated with absence of rheumatology visits. Those least likely to identify a specialist as primarily responsible for their SLE care included older subjects and those reporting lower incomes.
  
  
  CONCLUSIONS
  Although elderly subjects and those with lower incomes traditionally have access to health care through the Medicare and Medicaid programs, the presence of health insurance alone did not ensure equal utilization of care. This finding suggests that additional barriers to accessing rheumatology subspecialty care may exist in these patient populations.
authors.affiliation: University of California, San Francisco, CA 94143-0920, USA. Jinoos.Yazdany@ucsf.edu
authors.forename: Jinoos
authors.initials: J
authors.lastname: Yazdany
authors.forename: JoAnn Zell
authors.initials: JZ
authors.lastname: Gillis
authors.forename: Laura
authors.initials: L
authors.lastname: Trupin
authors.forename: Patricia
authors.initials: P
authors.lastname: Katz
authors.forename: Pantelis
authors.initials: P
authors.lastname: Panopalis
authors.forename: Lindsey A
authors.initials: LA
authors.lastname: Criswell
authors.forename: Edward
authors.initials: E
authors.lastname: Yelin
mesh_terms: D000328:Adult; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008180:Lupus Erythematosus, Systemic / Q000191:economics / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D010824:Physicians' Offices / Q000706:statistics & numerical data*; D011203:Poverty / Q000706:statistics & numerical data; D012219:Rheumatology / Q000706:statistics & numerical data*; D012923:Social Class; D014481:United States / Q000453:epidemiology