Disparities in time to diagnosis of Radiographic Axial Spondyloarthritis.

Abstract

Objective: Radiographic axial spondyloarthritis (r-axSpA) has a 7-year average diagnostic delay. While the impact of sex or gender on time to diagnosis has been evaluated, the role of social determinants of health remains understudied. We assessed whether time from initial clinical documentation of r-axSpA symptoms to r-axSpA diagnosis (diagnostic delay) varies based on sex, race, ethnicity, or the presence of social needs.

Methods: We studied patients with r-axSpA from a tertiary center from 2000 to 2022. The cohort was built with the Observational Health Data Sciences and Informatics (OHDSI) network. For the primary analysis, we assessed the time from back pain/spinal pain to r-axSpA diagnosis and secondarily, the time to r-axSpA from any other r-axSpA -related condition. To estimate differences in diagnostic delay, we employed a parametric survival model, accelerated failure time.

Results: We included 404 patients (mean age 49, 37% female), with 25.5% identifying as Black, 31.1% as other or unknown race and 14.1% as Hispanic. Patients with a documented social need had a 21% increase in time from back pain to r-axSpA diagnosis (95% CI 0.93, 1.56). In patients with any r-axSpA related condition, time to diagnosis increased similarly by 21% (95% CI 0.92, 1.57). Considering an average time to diagnosis of 34 months, a social need increased time to diagnosis by 7 months.

Conclusion: This study reveals a trend toward diagnostic delay in r-axSpA related to social need, sex, race, and ethnicity. Future studies should focus on referral strategies to enable prompt diagnosis and optimize care.