Racial Differences in Prevalence and Treatment for Psoriatic Arthritis and Ankylosing Spondylitis by Insurance Coverage in the USA
Tóm tắt
Patients with psoriatic arthritis (PsA) and ankylosing spondylitis (AS) may receive suboptimal care, and differences in care by race/ethnicity, sex, and insurance coverage are not well studied. This was a descriptive, retrospective cross-sectional US claims database analysis utilizing the Medicaid multi-state segment of the IBM® MarketScan® Commercial Claims and Encounters Supplemental Database and Optum Insight Clinformatics® Data Mart database for 2019. Patients aged ≥ 18 years with PsA or AS and continuous medical and pharmacy coverage were included. Outcomes evaluated were prevalence and percentage of patients receiving biologic disease-modifying antirheumatic drugs (bDMARDs)/targeted synthetic DMARDs (tsDMARDs) or visiting a rheumatologist. Outcomes were stratified by race/ethnicity, sex, and insurance coverage, with outcomes determined for commercial insurance, Medicare, and Medicaid enrollees. Differences observed in outcomes were numerical in nature. Prevalences of PsA and AS were highest for Medicare enrollees (320 and 156 per 100,000 persons [0.32 and 0.16%], respectively) and lowest for Medicaid enrollees (132 and 71 per 100,000 persons [0.13 and 0.07%], respectively). White patients had the greatest prevalence versus patients of other races/ethnicities. Females had a higher prevalence of PsA than males, while AS prevalence was generally lower for females versus males for each insurance category. The percentage of patients prescribed bDMARDs/tsDMARDs was highest for commercial insurance enrollees (PsA 63%, AS 43%) and lowest for Medicare enrollees (PsA 21%, AS 11%). The proportion of patients who saw a rheumatologist was lower for Medicaid enrollees (PsA 12%, AS 10%) than for commercial insurance or Medicare enrollees (PsA 68%, 55%; AS 67%, 42%). For commercial insurance and Medicare enrollees, the percentage of patients visiting a rheumatologist was similar by race/ethnicity but higher for females versus males. The prevalence and treatment of PsA and AS differs by race/ethnicity, insurance coverage, and sex in the USA. Efforts for improving access to care are needed to improve outcomes among all patients.
Tài liệu tham khảo
Feld J, Chandran V, Haroon N, Inman R, Gladman D. Axial disease in psoriatic arthritis and ankylosing spondylitis: a critical comparison. Nat Rev Rheumatol. 2018;14:363–71.
Ogdie A, Weiss P. The epidemiology of psoriatic arthritis. Rheum Dis Clin North Am. 2015;41:545–68.
Reveille JD. Epidemiology of spondyloarthritis in North America. Am J Med Sci. 2011;341:284–6.
Walsh J, Hunter T, Schroeder K, Sandoval D, Bolce R. Trends in diagnostic prevalence and treatment patterns of male and female ankylosing spondylitis patients in the United States, 2006–2016. BMC Rheumatol. 2019;3:39.
Feld J, Ye JY, Chandran V, et al. Is axial psoriatic arthritis distinct from ankylosing spondylitis with and without concomitant psoriasis? Rheumatology (Oxford). 2020;59:1340–6.
Jadon DR, Sengupta R, Nightingale A, et al. Axial Disease in Psoriatic Arthritis study: defining the clinical and radiographic phenotype of psoriatic spondyloarthritis. Ann Rheum Dis. 2017;76:701–7.
Ogdie A, Coates LC, Gladman DD. Treatment guidelines in psoriatic arthritis. Rheumatology (Oxford). 2020;59:i37–46.
Ward MM, Deodhar A, Gensler LS, et al. 2019 Update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis. Arthritis Care Res (Hoboken). 2019;71:1285–99.
Favier G, Gladman DD, Merola JF, Armstrong AW, Boehncke WH, Helliwell PS. Benchmarking care in psoriatic arthritis—the QUANTUM Report: a report from the GRAPPA 2016 Annual Meeting. J Rheumatol. 2017;44:674–8.
Deodhar A, Mease PJ, Reveille JD, et al. Frequency of axial spondyloarthritis diagnosis among patients seen by US Rheumatologists for Evaluation of Chronic Back Pain. Arthritis Rheumatol. 2016;68:1669–76.
Deodhar A, Mittal M, Reilly P, et al. Ankylosing spondylitis diagnosis in US patients with back pain: identifying providers involved and factors associated with rheumatology referral delay. Clin Rheumatol. 2016;35:1769–76.
Mease PJ, Liu C, Siegel E, et al. Impact of clinical specialty setting and geographic regions on disease management in patients with psoriatic arthritis in the United States: a multicenter observational study. Am J Clin Dermatol. 2019;20:873–80.
Kavanaugh A, Helliwell P, Ritchlin CT. Psoriatic arthritis and burden of disease: patient perspectives from the population-based multinational assessment of psoriasis and psoriatic arthritis (MAPP) survey. Rheumatol Ther. 2016;3:91–102.
Law L, Beckman Rehnman J, Deminger A, Klingberg E, Jacobsson LTH, Forsblad-d’Elia H. Factors related to health-related quality of life in ankylosing spondylitis, overall and stratified by sex. Arthritis Res Ther. 2018;20:284.
Keisler-Starkey K, Bunch LN. Health Insurance coverage in the United States: 2019. 2020. https://www.census.gov/content/dam/Census/library/publications/2020/demo/p60-271.pdf. Accessed 9 Aug 2021.
IBM Watson Health. Data brochure. IBM MarketScan Research Databases for life sciences researchers. 2020. https://www.ibm.com/downloads/cas/OWZWJ0QO. Accessed 26 Feb 2021.
Optum. Clinformatics® data mart. 2017. https://www.optum.com/content/dam/optum3/optum/en/resources/white-papers/clinformatics-data-mart.pdf. Accessed 26 Feb 2021.
Gelfand JM, Stern RS, Nijsten T, et al. The prevalence of psoriasis in African Americans: results from a population-based study. J Am Acad Dermatol. 2005;52:23–6.
Kerr GS, Qaiyumi S, Richards J, et al. Psoriasis and psoriatic arthritis in African–American patients—the need to measure disease burden. Clin Rheumatol. 2015;34:1753–9.
Singh DK, Magrey M. Racial differences in clinical features and comorbidities in ankylosing spondylitis in the United States. J Rheumatol. 2020;47:835–8.
Reveille JD, Hirsch R, Dillon CF, Carroll MD, Weisman MH. The prevalence of HLA-B27 in the US: data from the US National Health and Nutrition Examination Survey, 2009. Arthritis Rheum. 2012;64:1407–11.
Chen B, Li J, He C, et al. Role of HLA-B27 in the pathogenesis of ankylosing spondylitis (review). Mol Med Rep. 2017;15:1943–51.
Karmacharya P, Balls-Berry JE, Davis JM 3rd. True difference or detection bias: racial differences in clinical features and comorbidities in Ankylosing Spondylitis in the United States. J Rheumatol. 2020;47:1150.
Obermeyer Z, Powers B, Vogeli C, Mullainathan S. Dissecting racial bias in an algorithm used to manage the health of populations. Science. 2019;366:447–53.
Alexis AF, Blackcloud P. Psoriasis in skin of color: epidemiology, genetics, clinical presentation, and treatment nuances. J Clin Aesthet Dermatol. 2014;7:16–24.
Alinaghi F, Calov M, Kristensen LE, et al. Prevalence of psoriatic arthritis in patients with psoriasis: a systematic review and meta-analysis of observational and clinical studies. J Am Acad Dermatol 2019;80:251–65.e19.
Ashman JJ, Hing E, Talwalkar A. Variation in physician office visit rates by patient charateristics and state, 2012. 2015. https://www.cdc.gov/nchs/products/databriefs/db212.htm. Accessed 8 Jun 2021.
Kavanaugh A, Singh R, Karki C, et al. Disease activity and biologic use in patients with psoriatic arthritis or rheumatoid arthritis. Clin Rheumatol. 2018;37:2275–80.
Centers for Medicare & Medicaid Services. Medicare offers more health coverage choices and decreased premiums in 2018. 2017. https://www.cms.gov/newsroom/press-releases/medicare-offers-more-health-coverage-choices-and-decreased-premiums-2018.
U.S. Department of Health and Human Services. Health care coverage analyses of the 2006 national healthcare quality and disparities reports. 2008. https://www.medicaid.gov/medicaid/quality-of-care/downloads/health-coverage-analyses-of-nhqr.pdf. Accessed 4 Mar 2021.
Han X, Call KT, Pintor JK, Alarcon-Espinoza G, Simon AB. Reports of insurance-based discrimination in health care and its association with access to care. Am J Public Health. 2015;105(Suppl 3):S517–25.
Churchwell K, Elkind MSV, Benjamin RM, et al. Call to action: structural racism as a fundamental driver of health disparities: a presidential advisory from the American Heart Association. Circulation. 2020;142:e454–68.
Dovey ZS, Nair SS, Chakravarty D, Tewari AK. Racial disparity in prostate cancer in the African American population with actionable ideas and novel immunotherapies. Cancer Rep (Hoboken). 2021:e1341.
Peek ME, Simons RA, Parker WF, Ansell DA, Rogers SO, Edmonds BT. COVID-19 among African Americans: an action plan for mitigating disparities. Am J Public Health. 2021;111:286–92.
Jamalyaria F, Ward MM, Assassi S, et al. Ethnicity and disease severity in ankylosing spondylitis a cross-sectional analysis of three ethnic groups. Clin Rheumatol. 2017;36:2359–64.
Mauvais-Jarvis F, Bairey Merz N, Barnes PJ, et al. Sex and gender: modifiers of health, disease, and medicine. Lancet. 2020;396:565–82.