Aboriginal RA Population Treated with Biologics: Why are there More Complications, Less Benefit?

Cheryl Barnabe reported data from the Alberta Biologics Pharmacosurveillance Program (ABioPharm) which follows more than 1500 RA patients, of whom 83 are Aboriginals, with a total of 8000 patient-years of observation. 

Are there health disparities between the groups? You may at first say no, as the Aboriginals who obtained biologics for RA got them at a younger age (50 years of age vs. 55 for non-Aboriginals). They had the same disease duration, but Aboriginals  were more apt to smoke, had received more DMARDs prior to starting biologics, and more were seropositive (68% vs. 46%). 

However, I don't know what % of Aboriginals were offered biologics at equal disease activity vs. the Non-Aboriginals in the cohort. We do know that more comorbidities, higher baseline DAS28 ESR scores (6.1 vs 5.2) and slower rates of improvement for joint counts were found, demonstrating more active disease and worse outcomes in the Aboriginal group. 

What is also very concerning is that Aboriginals had a higher rate of hospitalizations, serious infections, thromboembolic events, and cancer, but perhaps surprisingly, an equal number of cardiovascular events.

In a separate systematic review by the same group, it seems that Aboriginal patients are more likely to receive care for their RA from their primary care physician than from a rheumatologist compared to others, and this could be due to longer distances to travel to their specialist or other access barriers.

The take home message is that we have to study and understand health disparities and then do research on implementation of processes that could reduce barriers to care since there are important outcome differences which could be due to nature, nuture, other factors, or all of the above.

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