Worse outcomes linked to ethnicity for early inflammatory arthritis in England and Wales: a national cohort study

Maryam A Adas; Sam Norton; Sathiyaa Balachandran; Edward Alveyn; Mark D Russell; Thomas Esterine; Paul Amlani-Hatcher; Sarah Oyebanjo; Heidi Lempp; Joanna Ledingham; Kanta Kumar; James B Galloway; Shirish Dubey

doi:10.1093/rheumatology/keac266

Worse outcomes linked to ethnicity for early inflammatory arthritis in England and Wales: a national cohort study

Maryam A Adas, Sam Norton, Sathiyaa Balachandran, Edward Alveyn, Mark D Russell, Thomas Esterine, Paul Amlani-Hatcher, Sarah Oyebanjo, Heidi Lempp, Joanna Ledingham, Kanta Kumar, James B Galloway, Shirish Dubey

1Department of Hepatology, Imperial College London, London, UK. 2Institute of Liver Studies at King's College School of Medicine at King's College Hospital, London, UK. 3Institute of Human Health and Performance, University College London, London, UK. 4Department of Asthma Allergy and Lung Biology, King's College London, London, UK. 5Division of Critical Care Medicine, University of Alberta, Edmonton, Canada.
American College of Rheumatology, British Society for Rheumatology and British Society for Immunology
Portsmouth Hospitals University NHS Trust
School of Psychology, University of Birmingham, Birmingham, United Kingdom; Department of Psychology, School of Life and Health Sciences, Aston University, Birmingham, United Kingdom.
Clinical Genetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.

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Abstract

OBJECTIVE: To assess variability in care quality and treatment outcomes across ethnicities in early inflammatory arthritis (EIA).

METHODS: We conducted an observational cohort study in England and Wales from May 2018-March 2020, including patients with a suspected/confirmed EIA diagnosis. Care quality was assessed against six metrics defined by national guidelines. Clinical outcomes were measured using DAS28. Outcomes between ethnic groups ('White', 'Black', 'Asian', 'Mixed, 'Other') were compared, and adjusted for confounders.

RESULTS: 35,807 eligible patients were analysed. Of those, 30,643 (85.6%) were White and 5,164 (14.6%) were from ethnic minorities: 1,035 (2.8%) Black; 2,617 (7.3%) Asian; 238 (0.6%) Mixed; 1,274 (3.5%) Other. 12,955 patients had confirmed EIA, of whom 11,315 were White and 1,640 were from ethnic minorities: 314 (2.4%) Black; 927 (7.1%) Asian; 70 (0.5%) Mixed; 329 (2.5%) Other.14,803 patients were assessed by rheumatology within three weeks, and 5,642 started treatment within six weeks of referral. There were no significant differences by ethnicity. Ethnic minority patients had lower odds of disease remission at three months (adjusted odds ratio 0.79 [95% CI: 0.65,0.96]) relative to White patients. Ethnic minorities were significantly less likely to receive initial treatment with methotrexate (0.68 [0.52-0.90]) or with glucocorticoids (0.63 [0.49-0.80]).

CONCLUSION: We demonstrate that some ethnic minorities are less likely to achieve disease remission in three months following EIA diagnosis. This is not explained by delays in referral or time to treatment. Our data highlight the need for investigation into the possible drivers of these inequitable outcomes and reappraisal of EIA management pathways.

Original language	English
Journal	Rheumatology
Early online date	10 May 2022
DOIs	https://doi.org/10.1093/rheumatology/keac266
Publication status	E-pub ahead of print - 10 May 2022

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Worse outcomes linked to_ADAS_Publishedonline10May2022_GOLD VoR CC BY NCFinal published version, 2.25 MBLicence: CC BY-NC

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Adas, M. A., Norton, S., Balachandran, S., Alveyn, E., Russell, M. D., Esterine, T., Amlani-Hatcher, P., Oyebanjo, S., Lempp, H., Ledingham, J., Kumar, K., Galloway, J. B., & Dubey, S. (2022). Worse outcomes linked to ethnicity for early inflammatory arthritis in England and Wales: a national cohort study. Rheumatology. Advance online publication. https://doi.org/10.1093/rheumatology/keac266

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title = "Worse outcomes linked to ethnicity for early inflammatory arthritis in England and Wales: a national cohort study",

abstract = "OBJECTIVE: To assess variability in care quality and treatment outcomes across ethnicities in early inflammatory arthritis (EIA).METHODS: We conducted an observational cohort study in England and Wales from May 2018-March 2020, including patients with a suspected/confirmed EIA diagnosis. Care quality was assessed against six metrics defined by national guidelines. Clinical outcomes were measured using DAS28. Outcomes between ethnic groups ('White', 'Black', 'Asian', 'Mixed, 'Other') were compared, and adjusted for confounders.RESULTS: 35,807 eligible patients were analysed. Of those, 30,643 (85.6%) were White and 5,164 (14.6%) were from ethnic minorities: 1,035 (2.8%) Black; 2,617 (7.3%) Asian; 238 (0.6%) Mixed; 1,274 (3.5%) Other. 12,955 patients had confirmed EIA, of whom 11,315 were White and 1,640 were from ethnic minorities: 314 (2.4%) Black; 927 (7.1%) Asian; 70 (0.5%) Mixed; 329 (2.5%) Other.14,803 patients were assessed by rheumatology within three weeks, and 5,642 started treatment within six weeks of referral. There were no significant differences by ethnicity. Ethnic minority patients had lower odds of disease remission at three months (adjusted odds ratio 0.79 [95% CI: 0.65,0.96]) relative to White patients. Ethnic minorities were significantly less likely to receive initial treatment with methotrexate (0.68 [0.52-0.90]) or with glucocorticoids (0.63 [0.49-0.80]).CONCLUSION: We demonstrate that some ethnic minorities are less likely to achieve disease remission in three months following EIA diagnosis. This is not explained by delays in referral or time to treatment. Our data highlight the need for investigation into the possible drivers of these inequitable outcomes and reappraisal of EIA management pathways.",

author = "Adas, {Maryam A} and Sam Norton and Sathiyaa Balachandran and Edward Alveyn and Russell, {Mark D} and Thomas Esterine and Paul Amlani-Hatcher and Sarah Oyebanjo and Heidi Lempp and Joanna Ledingham and Kanta Kumar and Galloway, {James B} and Shirish Dubey",

note = "{\textcopyright} The Author(s) 2022. Published by Oxford University Press on behalf of the British Society for Rheumatology.",

year = "2022",

month = may,

day = "10",

doi = "10.1093/rheumatology/keac266",

language = "English",

journal = "Rheumatology",

issn = "1462-0324",

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TY - JOUR

T1 - Worse outcomes linked to ethnicity for early inflammatory arthritis in England and Wales

T2 - a national cohort study

AU - Adas, Maryam A

AU - Norton, Sam

AU - Balachandran, Sathiyaa

AU - Alveyn, Edward

AU - Russell, Mark D

AU - Esterine, Thomas

AU - Amlani-Hatcher, Paul

AU - Oyebanjo, Sarah

AU - Lempp, Heidi

AU - Ledingham, Joanna

AU - Kumar, Kanta

AU - Galloway, James B

AU - Dubey, Shirish

PY - 2022/5/10

Y1 - 2022/5/10

N2 - OBJECTIVE: To assess variability in care quality and treatment outcomes across ethnicities in early inflammatory arthritis (EIA).METHODS: We conducted an observational cohort study in England and Wales from May 2018-March 2020, including patients with a suspected/confirmed EIA diagnosis. Care quality was assessed against six metrics defined by national guidelines. Clinical outcomes were measured using DAS28. Outcomes between ethnic groups ('White', 'Black', 'Asian', 'Mixed, 'Other') were compared, and adjusted for confounders.RESULTS: 35,807 eligible patients were analysed. Of those, 30,643 (85.6%) were White and 5,164 (14.6%) were from ethnic minorities: 1,035 (2.8%) Black; 2,617 (7.3%) Asian; 238 (0.6%) Mixed; 1,274 (3.5%) Other. 12,955 patients had confirmed EIA, of whom 11,315 were White and 1,640 were from ethnic minorities: 314 (2.4%) Black; 927 (7.1%) Asian; 70 (0.5%) Mixed; 329 (2.5%) Other.14,803 patients were assessed by rheumatology within three weeks, and 5,642 started treatment within six weeks of referral. There were no significant differences by ethnicity. Ethnic minority patients had lower odds of disease remission at three months (adjusted odds ratio 0.79 [95% CI: 0.65,0.96]) relative to White patients. Ethnic minorities were significantly less likely to receive initial treatment with methotrexate (0.68 [0.52-0.90]) or with glucocorticoids (0.63 [0.49-0.80]).CONCLUSION: We demonstrate that some ethnic minorities are less likely to achieve disease remission in three months following EIA diagnosis. This is not explained by delays in referral or time to treatment. Our data highlight the need for investigation into the possible drivers of these inequitable outcomes and reappraisal of EIA management pathways.

AB - OBJECTIVE: To assess variability in care quality and treatment outcomes across ethnicities in early inflammatory arthritis (EIA).METHODS: We conducted an observational cohort study in England and Wales from May 2018-March 2020, including patients with a suspected/confirmed EIA diagnosis. Care quality was assessed against six metrics defined by national guidelines. Clinical outcomes were measured using DAS28. Outcomes between ethnic groups ('White', 'Black', 'Asian', 'Mixed, 'Other') were compared, and adjusted for confounders.RESULTS: 35,807 eligible patients were analysed. Of those, 30,643 (85.6%) were White and 5,164 (14.6%) were from ethnic minorities: 1,035 (2.8%) Black; 2,617 (7.3%) Asian; 238 (0.6%) Mixed; 1,274 (3.5%) Other. 12,955 patients had confirmed EIA, of whom 11,315 were White and 1,640 were from ethnic minorities: 314 (2.4%) Black; 927 (7.1%) Asian; 70 (0.5%) Mixed; 329 (2.5%) Other.14,803 patients were assessed by rheumatology within three weeks, and 5,642 started treatment within six weeks of referral. There were no significant differences by ethnicity. Ethnic minority patients had lower odds of disease remission at three months (adjusted odds ratio 0.79 [95% CI: 0.65,0.96]) relative to White patients. Ethnic minorities were significantly less likely to receive initial treatment with methotrexate (0.68 [0.52-0.90]) or with glucocorticoids (0.63 [0.49-0.80]).CONCLUSION: We demonstrate that some ethnic minorities are less likely to achieve disease remission in three months following EIA diagnosis. This is not explained by delays in referral or time to treatment. Our data highlight the need for investigation into the possible drivers of these inequitable outcomes and reappraisal of EIA management pathways.

U2 - 10.1093/rheumatology/keac266

DO - 10.1093/rheumatology/keac266

M3 - Article

C2 - 35536178

SN - 1462-0324

JO - Rheumatology

JF - Rheumatology

ER -

Worse outcomes linked to ethnicity for early inflammatory arthritis in England and Wales: a national cohort study

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