Hear from Ash Samanta, chair of our Ethnicity special interest group (SIG), on the interplay between ethnicity and early inflammatory arthritis.
Inequalities in healthcare have long been recognised as an issue needing urgent attention. BSR, along with members working at the forefront of this field, has long campaigned for equality in care for rheumatology patients from minority ethnic groups.
There have been a number of different reasons suggested as to why inequalities might exist. Patients from minority groups may not access or be able to access healthcare systems, or may even be less willing to do so or lack confidence in the system.
The National Early Inflammatory Arthritis Audit (NEIAA), a programme of work that aims to improve the quality of care for people living with inflammatory arthritis, recently published a short report on the link between ethnicity and health outcomes.
The key findings within the report are that Black, Asian and ethnic minority patients were younger, less likely to smoke and more likely to be referred by their GP within three working days, but were less likely to achieve remission at three months. They were also more likely to report anxiety about their condition when compared to their white counterparts.
Performance process measures (in terms of recognition of potential early inflammatory arthritis and early referral) suggest equality. However, the outcomes are different. Disease remission after three months was different between the two groups, being less favourable with regard to those from minority ethnic backgrounds. A lower proportion who were Black, Asian and ethnic minority patients achieved disease remission compared to white patients (30% vs 37%) on the basis of clinician-reported outcomes. Patients from minority ethnic groups are also less likely to have received regular annual reviews.
These are real world data describing for the first time the magnitude of differences and outcomes for Black, Asian and ethnic minority patients. Although long suspected on a clinical basis, there's now clear evidence from the NEIAA report that differences in outcomes exist amongst new presentations of inflammatory arthritis in England and Wales.
The key question is why, especially when performance measures, such as lead referral times and starting disease-modifying treatment, are the same for both groups. There are a number of possible reasons for this. These include lack of understanding of the significance of inflammatory arthritis amongst these groups, insufficient emphasis on educational materials, and cultural differences in respect to acceptance and continuation of medication. All these matters (and other potential issues) require further exploration.
Although we've focused upon inequality in terms of services and use of services so far, there's an important difference; inequity in outcomes. This underscores the need for understanding the reasons for this inequity and for developing culturally acceptable and competent patient-centred treatment strategies.
BSR deserves plaudits for providing much needed data within this under-explored area. The findings of the NEIAA are being showcased at Annual Conference in 2022, and deserve the attention of all clinicians who continue to treat patients within an expanding multicultural environment.