Older, lower income patients least likely to see a specialist for lupus

April 30, 2007

Despite advances in treatment, systemic lupus erythematosus (SLE) remains a serious disease. Previous studies have shown that racial and ethnic minorities and individuals with low socioeconomic status may have poorer outcomes in the long run. Other research has shown that care provided by specialists to patients with rheumatic diseases is associated with improved outcomes yet does not cost more. A new study published in the May 2007 issue of Arthritis Care & Research (http://www.interscience.wiley.com/journal/arthritiscare) found older patients and those with lower incomes were less likely to see a specialist for SLE.

Between 2002 and 2004, researchers led by Jinoos Yazdany, MD, MPH, of the University of California, San Francisco, CA, conducted extensive telephone interviews with 982 SLE patients that included questions about visits to a rheumatologist within the past year, race/ethnicity, income, age, sex, disease severity, and type of insurance. Almost half of the participants reported a disease flare in the previous 3 months, and 22 percent reported no visits to a rheumatologist, although most of these had been seen by another type of physician.

The results showed that patients 50 or older and those with lower incomes reported far fewer visits to a rheumatologist, and that male patients were less likely to see this type of specialist than female patients. Patients falling into these groups were also less likely to identify any kind of specialist as their primary SLE physician.

The authors suggest that elderly individuals or those with lower incomes face barriers to accessing care that may include a lack of rheumatology services close by, a lack of awareness of this type of specialty, less frequent referrals to rheumatologists, or inadequate follow-up. "Subjects who were older than 50 years or in the lowest income category were twice as likely to report no rheumatology visits in the past year," the authors note. These findings are striking because the current study's patients were chosen from a pool of participants reenrolling from a previous UCSF SLE study who presumably had greater access to care than SLE patients in the general population.

Regarding why men were less likely to see a rheumatologist, the authors suggest that the relatively low prevalence of SLE among men may play a role. "Both physician referral patterns for men with SLE and male patients' perceptions of disease warrant further study in this predominantly female disease," they state.

The authors point out that although elderly patients and those with lower incomes traditionally have access to health care through Medicare and Medicaid, the presence of health insurance alone did not ensure equal utilization of care. "This finding suggests that additional barriers to accessing rheumatology subspecialty care may exist in these patient populations," they conclude.
Article: "Association of Socioeconomic and Demographic Factors with Utilization of Rheumatology Subspecialty Care in a Large Observational Cohort of Subjects with Systemic Lupus Erythematosus," Jinoos Yazdany, Joann Zell Gillis, Laura Trupin, Patricia P. Katz, Pantelis Panopalis, Lindsey A. Criswell, Edward H. Yelin, Arthritis Care & Research, May 2007; (DOI: 10.1002/art.22674).


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