Disparities in care by insurance status for individuals with rheumatoid arthritis: analysis of the medical expenditure panel survey, 2006–2009

Abstract

Objective: Treatment guidelines for rheumatoid arthritis (RA) recommend early, aggressive treatment with nonbiologic and biologic disease-modifying antirheumatic drugs (DMARDs) to minimize long-term disability. We aimed to assess differences in medical resource utilization, drug therapy, and health outcomes among RA patients by insurance type in the United States.

Methods: Individuals with a self-reported diagnosis of RA were identified in the Medical Expenditure Panel Survey (MEPS) database, 2006–2009. Data regarding sociodemographic characteristics, insurance type and status, and outcomes (including health care resource utilization, prescription medication use, health status, and patient-reported barriers to health care) were extracted. Multivariable regression analyses were used to examine the impact of insurance type (private, Medicare, Medicaid, or uninsured) on outcome measures while controlling for age group, sex, and race/ethnicity.

Results: A total of 693 individuals with a self-reported diagnosis of RA during the study period were identified; 423 were aged 18–64 years and 270 were aged ≥65 years. Among patients aged 18–64, those with Medicaid or who were uninsured were less likely than those with private insurance to visit a rheumatologist (adjusted odds ratio [aOR] 0.13 and 0.17, respectively; p < .001) and to receive biologic DMARDS (aOR 0.09 [p < .001] and 0.16 [p < .01], respectively); those with Medicaid were also less likely to receive nonbiologic DMARDS (aOR 0.26 [p < .01]). Those with Medicaid were more likely than those with private insurance to be unable/delayed in getting prescription drugs (aOR 2.9 [p < .05]), to experience cognitive, social, and physical limitations (aOR 8.7 [p < .001], 4.7 [p < .001], and 2.5 [p < .05], respectively); they also reported significantly lower general health and health-related quality of life. Patients aged ≥65 experienced greater equity in care and outcomes.

Conclusions: Younger RA patients with Medicaid (including those who receive coverage under the Medicaid expansion component of the Affordable Care Act) may be at risk for inadequate treatment.

Keywords:

• Access to care
• Insurance coverage
• Patient-reported outcomes
• Rheumatoid arthritis

Transparency

Declaration of funding

The research reported in this manuscript was funded by AbbVie Inc. AbbVie Inc. participated in the study design, research, data collection, analysis and interpretation, and writing, reviewing and approving this publication. All authors had access to the data and participated in the development, review and approval, and in the decision to submit this publication.

Authors’ contributions: M.C., M.T.H. and A.G. conceptualized the research and contributed to the interpretation of the data. M.T.H. and J.R. wrote the statistical analysis plan and analyzed the data. M.C., M.T.H., A.G. and J.R. drafted and revised the paper. All authors contributed to manuscript development and reviewed and approved the content of the submitted manuscript.

Declaration of financial/other relationships

M.C. has disclosed that she is a former employee of AbbVie and may own AbbVie stock or stock options. A.G. has disclosed that he is an employee of AbbVie and may own AbbVie stock or stock options. J.R. has disclosed that she is an employee of RTI International, which is under contract with AbbVie. M.T.H. has disclosed that he is a former employee of RTI International and received research funding and consulting fees from AbbVie.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

Eric Bertelsen PhD of Arbor Communications Inc. (a member of the Fishawack group of companies), Conshohocken, PA, USA provided medical writing and editing services in the development of this manuscript. Financial support for these services was provided by AbbVie.