Racial Disparities in Rheumatology: What Are We Doing About It?

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The data tell the story. Despite improvements in overall outcomes for common rheumatologic conditions, such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), white patients fare better than minority patients, and sometimes substantially better. Even with new biologic therapies that have significantly altered the course of disease for patients with RA, outcomes for minorities lag behind those of whites. A 2013 study by Greenberg et al. showed that white patients with RA had significantly improved outcomes compared with minority patients. Using data collected from a large cohort of community-based rheumatology practices on patients treated between 2005 and 2007 and 2010 and 2012, the study found that disease activity levels and remission rates in whites were significantly better than in minorities during both time periods.¹

For patients with lupus, data on outcomes, incidence and prevalence rates continue to show that non-whites bear the greater burden of this disease. Recent studies continue to show a higher incidence and prevalence rates of lupus in minorities compared with whites, with the highest prevalence rates in non-Hispanic black women.^2-4 In addition, blacks have earlier onset of the disease and experience increased rates of renal disease and progression to end-stage renal disease (ESRD) compared with whites.⁴

These recent studies are just a sampling of data long established on the disparate outcomes seen between whites and minorities in rheumatology, and mirror what is well documented in other clinical areas. Just do a PubMed search with “racial disparities” as the search term, and thousands of studies come up documenting and discussing this issue across most, if not all, areas of healthcare.

Recognition of the range and depth of this problem across medicine was highlighted in a report published in 2002 by the Institutes of Health (IOH), titled “Unequal Treatment,” which focused national attention on racial and ethnic disparities in health and spurred the creation of an annual report published by the Agency for Healthcare Research and Quality (AHRQ) that reports on healthcare quality and disparities.⁵ Called the National Healthcare Quality and Disparities Report, it provides an annual update on quality of and access to healthcare. More recently, national efforts to reduce health disparities include the Department of Health and Human Services (HHS) Disparities Action Plan in 2011 and the expansion of insurance coverage under the Affordable Care Act.

Just do a PubMed search with ‘racial disparities’ as the search term, & thousands of studies come up.

You can find current data on these efforts and a good discussion of key questions and answers about health disparities at the Henry J Kaiser Family Foundation (KFF).6 Among the important issues addressed by the KFF is the complex and interrelated variables that contribute to health disparities, including social/environmental factors (e.g., poverty, education, proximity to care and neighborhood safety), health system (e.g., how healthcare is organized, financed and delivered), patient factors (e.g., health behaviors) and provider factors (e.g., bias and cultural/linguistic barriers to patient-provider communication).⁶