title: Treatment of rheumatoid arthritis in the Medicare Current Beneficiary Survey.
abstract: BACKGROUND
  Numerous studies across different health systems have documented that many patients with rheumatoid arthritis (RA) do not receive disease-modifying anti-rheumatic drugs (DMARDs). Relatively little is known about correlates of DMARD use and whether there are socioeconomic and demographic disparities. We examined DMARD use during 2001 to 2006 in the Medicare Current Beneficiary Survey (MCBS), a longitudinal US survey of randomly selected Medicare beneficiaries.
  
  
  METHODS
  Participants in MCBS with RA were included in the analyses, and DMARD use was based on an in-home assessment of all medications. Variables included as potential correlates of DMARD use in weighted regression models included race/ethnicity, insurance, income, education, rheumatology visit, region, age, gender, comorbidity index, and calendar year.
  
  
  RESULTS
  The cohort consisted of 509 MCBS participants with a diagnosis code for RA. Their median age was 70 years, 72% were female, and 24% saw a rheumatologist. Rates of DMARD use ranged from 37% among those <75 years of age to 25% of those age 75 to 84 and 4% of those age 85 and older. The multivariable adjusted predictors of DMARD use include: visit with a rheumatologist in the prior year (odds ratio, OR, 7.74, 95% CI, 5.37, 11.1) and older patient age (compared with <75 years, ages 75 to 84, OR 0.58, 95% CI 0.37, 0.92, and 85 and over, OR 0.09, 95% CI 0.02, 0.31). In those without a rheumatology visit, lower income and older age were associated with a significantly reduced probability of DMARD use; no association of DMARD use with income or age was observed for subjects seen by rheumatologists. Race and ethnicity were not significantly associated with receipt of DMARDs.
  
  
  CONCLUSIONS
  Among individuals not seeing rheumatologists, lower income and older age were associated with a reduced probability of DMARD use.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Solomon
authors.forename: Edward
authors.initials: E
authors.lastname: Yelin
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Katz
authors.forename: Bing
authors.initials: B
authors.lastname: Lu
authors.forename: Tamara
authors.initials: T
authors.lastname: Shaykevich
authors.forename: John Z
authors.initials: JZ
authors.lastname: Ayanian
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D015331:Cohort Studies; D003625:Data Collection; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014481:United States
chemical_list: D018501:Antirheumatic Agents