OA40 How ethnicity influences outcomes in early inflammatory arthritis - equality but not equity: findings from a national cohort. (23rd April 2022)

• Record Type: Journal Article
• Authors: Adas, Maryam; Balachandran, Sathiyaa; Esterine, Thomas; Amlani-Hatcher, Paul; Oyebanjo, Sarah; Lempp, Heidi; Ledingham, Joanna; Galloway, James; Kumar, Kanta; Dubey, Shirish
• Is Part Of: Rheumatology. Volume 61(2022)Supplement 1
• Publication Date: 2022-04-23
• Subjects: Rheumatism -- Periodicals; Rheumatology -- Periodicals; 616.723005
• DOI: 10.1093/rheumatology/keac132.040
• Languages: English
• ISSNs: 1462-0324

Abstract

Abstract: Background/Aims: Patients of Black, Asian and Minority Ethnic (BAME) backgrounds are more likely to report poorer health and low life expectancy. Focusing on patients with early inflammatory arthritis (EIA), we used the National Early Inflammatory Arthritis Audit (NEIAA) to evaluate the relationship between ethnicity, clinician and patient reported outcomes against the seven quality metrics set out in NICE (National Institute for Health and Clinical Excellence) quality standard QS33. Methods: The study is an observational cohort design. Data were from adult patients newly diagnosed with EIA first seen within rheumatology services in England and Wales between May 2018 and March 2020. Ethnicity was grouped into the following binary categories of ethnic minority groups: BAME (including Black British/African/Caribbean, Asian/Asian British, mixed, other) and White. Analyses were performed on sociodemographic, quality metrics, clinical and patient reported outcomes at baseline and three months follow up. Logistic regression was used to calculate the odds of disease remission and meeting quality metrics by ethnicity. Models were adjusted for age, gender, smoking, comorbidity, deprivation, and disease factors (seropositivity, disease severity [DAS28]). Results: A total of 35, 807 patients were included in the analyses. The BAME cohort accounted for 14% of patients and had proportionately more females. Smoking and comorbidity levels were lower. BAME patients were younger and more likely to be seropositive for rheumatoid factor or CCP antibodies. Compared to White patients, BAME patients were more likely to be referred within 3 days of suspicion of EIA and start treatment within 6 weeks. However, BAME patients had lower odds of disease remission at 3 months follow up despite multilevel adjustments and reported more symptoms of depression and anxiety. Detailed data on clinical and patient reported outcomes after 3 months of specialist care are presented in the table below. Conclusion: Although there is parity between care delivery for BAME and White patients, BAME patients had worse outcomes in this large multinational cohort. Urgent attention needs to be paid to further investigating the reasons for this and redesigning care pathways to address this inequity. Disclosure: M. Adas: None. S. Balachandran: None. T. Esterine: None. P. Amlani-Hatcher: None. S. Oyebanjo: None. H. Lempp: Other; HL is the coordinator of the Patient Panel of the NEIAA. J. Ledingham: Other; is a BSR trustee. J. Galloway: Honoraria; has received honoraria from AbbVie, Celgene, Chugai, Gilead, Janssen, Eli Lilly, Pfizer, Roche and UCB. K. Kumar: None. S. Dubey: Other; has been paid financial compensation for educational meeting on impact of ethnicity sponsored by Janssen.