title: Use of Biologic Therapy in Racial Minorities With Rheumatoid Arthritis From 2 US Health Care Systems.
abstract: BACKGROUND
  In the United States, there is racial/ethnic disparity in the care of rheumatoid arthritis (RA), yet there are limited data regarding the impact of varied health care systems on treatment outcomes.
  
  
  OBJECTIVE
  The aim fo this study was to compare the frequencies of use of disease-modifying antirheumatic drugs and biologic agents in racial minorities with RA in a single-payer and variable-access health systems.
  
  
  METHODS
  Rheumatoid arthritis disease status was examined in the Ethnic Minority Rheumatoid Arthritis Consortium (EMRAC) and Veterans Affairs Rheumatoid Arthritis Registry (VARA); frequencies of prednisone and disease-modifying antirheumatic drugs and biologic agent use at enrollment were documented. Comparisons in frequencies of RA therapies between RA cohorts and white and nonwhite racial subsets were evaluated.
  
  
  RESULTS
  The combined cohorts provided 2899 subjects for analysis (EMRAC = 943, VARA = 1956). Routine Assessment of Patient Index Data 3 and Disease Activity Score in 28 Joints scores were equivalent (cohort, racial subsets), as was biologic agent use (26% vs. 28%) between whites and nonwhites. Disease-modifying antirheumatic drug use was greater in EMRAC nonwhites compared with their white counterparts, but similar to all VARA patients (33% vs. 22% [P < 0.001], 36%, 39%, respectively). However, biologic agent use was significantly greater in EMRAC versus VARA patients (37% vs. 22%, P < 0.001). In VARA patients, there was no difference in biologic agent use among racial subsets (22% vs. 21%). In EMRAC patients, biologic agent use was greater in whites than in nonwhites (EMRAC white 45% vs. EMRAC nonwhite 33%, P < 0.001; odds ratio, 1.66) and compared with all VARA subjects (EMRAC white 45% vs. all VARA 22%, P < 0.001; odds ratio, 2.91). Younger age, advanced education, longstanding disease, and severe disease were associated with biologic agent use.
  
  
  CONCLUSIONS
  When compared with more variable-access systems, a VA system of care that includes a single-payer insurance may afford equality in use of biologic agents among different racial subsets.
authors.affiliation: From the *Rheumatology Section, Veterans Affairs Medical Center (VAMC); and †Division of Rheumatology, Georgetown and Howard University Hospitals, Washington, DC; ‡Department of Rheumatology, New York University School of Medicine, New York, NY; and §VA Nebraska-Western Iowa Health Care System and Nebraska Arthritis Outcomes Research Center; and ∥Division of Rheumatology, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Gail S
authors.initials: GS
authors.lastname: Kerr
authors.forename: Christopher
authors.initials: C
authors.lastname: Swearingen
authors.forename: Ted R
authors.initials: TR
authors.lastname: Mikuls
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Yazici
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000208:ethnology; D001688:Biological Products / Q000627:therapeutic use*; D001691:Biological Therapy / Q000379:methods; D005260:Female; D000069576:Health Equity / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D054525:Minority Health / Q000592:standards / Q000706:statistics & numerical data; D020380:Needs Assessment; D012042:Registries; D014481:United States / Q000453:epidemiology
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products