Escalation to Biologics After Methotrexate Among US Veterans with Rheumatoid Arthritis Grouped by Rural Versus Urban Areas.

IF 3.7 2区 医学 Q1 RHEUMATOLOGY Arthritis Care & Research Pub Date : 2024-10-28 DOI:10.1002/acr.25457
Anisha Naik, Aaron Baraff, Katherine D Wysham, Jean W Liew, Bryant R England, Punyasha Roul, Michael George, Joshua F Baker, Jennifer L Barton, Una E Makris, Gail Kerr, Grant W Cannon, Ted R Mikuls, Namrata Singh
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Abstract

Background: Racial and ethnic disparities in rheumatoid arthritis (RA) outcomes are well recognized. However, whether disparities in RA treatment selection and outcomes differ by urban versus rural residence, independent of race, have not been studied. Our objective was to evaluate whether biologic disease modifying anti-rheumatic drugs (bDMARD) initiation after methotrexate use differs by rural versus urban residence among Veterans with RA.

Methods: In this retrospective cohort study utilizing national U.S. Veterans Affairs databases, we identified adult patients with RA based on presence of diagnostic codes and DMARD use. We included patients receiving an initial prescription of methotrexate (index date) between 2005 and 2014, with data through 2016 used for follow-up. Urban-rural status was categorized using the Veteran Health Administration's Urban/Rural classification. Our primary outcome of interest was time to biologic initiation within two years of starting methotrexate. Multivariable Cox proportional hazards models were conducted adjusting for demographics, comorbidities, and rheumatoid factor or anti-CCP positivity.

Results: Among 17,395 veterans with RA (88% male, 42% with rural residence) fulfilling eligibility criteria, 3,259 (19%) initiated a biologic within the first two years of follow up. In multivariable models, residence in an urban area was associated with a statistically significant higher biologic use compared to rural areas (adjusted hazard ratio (aHR) 1.10, 95% CI 1.02-1.18).

Conclusion: Our study found only modest differences in initiation of biologic therapies among rural versus urban residing Veterans with RA in the VA healthcare system. These findings suggest that disparities are not easily explained by rurality within the VA healthcare system.

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按农村地区和城市地区分类的患有类风湿关节炎的美国退伍军人在使用甲氨蝶呤后升级使用生物制剂的情况。
背景:类风湿性关节炎(RA)治疗结果的种族和民族差异已得到公认。然而,对于类风湿关节炎治疗选择和结果的差异是否因城市和农村居住地的不同而不同(与种族无关),尚未进行研究。我们的目的是评估在患有 RA 的退伍军人中,使用甲氨蝶呤后开始使用生物疾病修饰抗风湿药(bDMARD)是否因居住地不同而存在差异:在这项利用美国退伍军人事务国家数据库进行的回顾性队列研究中,我们根据诊断代码和 DMARD 使用情况确定了 RA 成年患者。我们纳入了 2005 年至 2014 年间首次开具甲氨蝶呤处方(索引日期)的患者,并对截至 2016 年的数据进行了随访。城乡状况采用退伍军人健康管理局的城乡分类法进行分类。我们关注的主要结果是开始使用甲氨蝶呤后两年内开始使用生物制剂的时间。在对人口统计学、合并症、类风湿因子或抗CCP阳性进行调整后,我们建立了多变量Cox比例危险模型:在符合条件的17395名患有RA的退伍军人(88%为男性,42%居住在农村)中,有3259人(19%)在随访的头两年内开始使用生物制剂。在多变量模型中,与农村地区相比,居住在城市地区的患者使用生物制剂的比例明显更高(调整后危险比(aHR)1.10,95% CI 1.02-1.18):我们的研究发现,在退伍军人医疗保健系统中,农村与城市退伍军人中的RA患者在开始使用生物制剂治疗方面差异不大。这些研究结果表明,退伍军人医疗保健系统中的农村地区并不能轻易解释这种差异。
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来源期刊
CiteScore
9.40
自引率
6.40%
发文量
368
审稿时长
3-6 weeks
期刊介绍: Arthritis Care & Research, an official journal of the American College of Rheumatology and the Association of Rheumatology Health Professionals (a division of the College), is a peer-reviewed publication that publishes original research, review articles, and editorials that promote excellence in the clinical practice of rheumatology. Relevant to the care of individuals with rheumatic diseases, major topics are evidence-based practice studies, clinical problems, practice guidelines, educational, social, and public health issues, health economics, health care policy, and future trends in rheumatology practice.
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