Racial disparities in treatment preferences for rheumatoid arthritis.
BACKGROUND
Data suggest that differences in patient preferences may account for racial disparities in the use of medical interventions. Racial disparities have also been noted in outcomes and the delivery of healthcare services in chronic disease. Whether treatment preferences in chronic disease differ by race is not known.


METHODS
We elicited treatment preferences for aggressive therapy in patients with rheumatoid arthritis who identified themselves as being black or white.


RESULTS
One hundred fifty consecutive eligible patients were invited to participate. Of these, 136 subjects completed the interview. In unadjusted analysis, 51% of white participants preferred aggressive therapy compared with 16% of blacks (P < 0.0001). Subjects who were married and reported having at least some college education had stronger preferences for aggressive therapy compared with their respective counterparts. After adjusting for covariates, race remained the strongest predictor of aggressive therapy examined in this study [adjusted odds ratio (95% confidence interval) = 11.2 (1.9-64.9)].


CONCLUSIONS
In this study, fewer black patients preferred aggressive treatment compared with white patients with similar disease severity. These results have important clinical implications because use of aggressive treatment improves both short- and long-term outcomes in rheumatoid arthritis. Efforts to improve patient education and physician communication should be made to ensure that all patients have an accurate understanding of the benefits, as well as risks, associated with the best available treatment options.
Constantinescu
Florina
F
Virginia Commonwealth University, USA.
Goucher
Suzanne
S
Weinstein
Arthur
A
Fraenkel
Liana
L
D000328:Adult; D001741:Black or African American / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000145:classification / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology*; D003142:Communication; D003657:Decision Making; D004219:District of Columbia; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D054625:Healthcare Disparities; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D055118:Medication Adherence / Q000208:ethnology*; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D017060:Patient Satisfaction / Q000191:economics / Q000208:ethnology*; D011594:Psychometrics / Q000379:methods; D012219:Rheumatology; D012959:Socioeconomic Factors; D012984:Software; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014768:Virginia; D044465:White People / Q000523:psychology*; D055815:Young Adult
D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D008727:Methotrexate