Evaluation of Access Disparities to Biologic Disease-Modifying Antirheumatic Drugs in Rural and Urban Communities.

• Authors: Nicholas J Peterman, Medicine, Carle Foundation Hospital, Urbana, USA.; Aksai Vashi, Medicine, Carle Illinois College of Medicine, Urbana, USA.; Devan Govan, Medicine, Carle Illinois College of Medicine, Urbana, USA.; Amrit Bhatia, Medicine, University of Cincinnati College of Medicine, Cincinnati, USA.; Tejal Vashi, Statistics, Social & Scientific Systems, Atlanta, USA.; Brad Kaptur, Medicine, Carle Illinois College of Medicine, Urbana, USA.; Eunhae G Yeo, Medicine, Carle Illinois College of Medicine, Urbana, USA.; Alison Gizinski, Emory University
• Journal Title: Cureus
• Volume: Volume 14, Number 6
• Publisher: (publisher) | 2022-06, Pages e26448-e26448
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.7759/cureus.26448
• Subjects: Statistics
• Keywords: disease-modifying antirheumatic drugs; geospatial analysis; healthcare inequality; medicare data; rural vs metropolitan

Abstract

The American College of Rheumatology guidelines provides a strong recommendation for the use of biologic disease-modifying antirheumatic drugs (bDMARDs) when conventional rheumatoid arthritis treatments fail to meet treatment targets. Although bDMARDs are an effective and important treatment component, access inequalities remain a challenge in many communities worldwide. The purpose of this analysis is to assess nationwide trends in bDMARD access in the United States, with a specific focus on rural and urban access gaps. This study combined multiple county-level databases to assess bDMARD prescriptions from 2015 to 2019. Using geospatial analysis and the Moran's I statistic, counties were classified according to prescription levels to assess for hotspots and coldspots. Analysis of variance (ANOVA) was used to compare significant counties across 49 socioeconomic variables of interest. The analysis identified statistically significant hotspot and coldspot prescription clusters within the United States. Coldspot (Low-Low) clusters with low access to bDMARDs are located predominantly in the rural west North Central region, extending down to Oklahoma and Arkansas. Hotspot (High-High) clusters are seen in urban and metro areas of Wisconsin, Minnesota, Pennsylvania, North Carolina, Georgia, Oregon, and the southern tip of Texas. Comparing coldspot to hotspot areas of bDMARD access revealed that the Medicare populations were older, more rural, less educated, less impoverished, and less likely to get their bDMARDs from a rheumatologist.