Because Drs. Katz and Yelin are Editors of Arthritis Care & Research, review of this article was handled by the Editor of Arthritis & Rheumatism.
Association of socioeconomic and demographic factors with utilization of rheumatology subspecialty care in systemic lupus erythematosus
Article first published online: 30 APR 2007
Copyright © 2007 by the American College of Rheumatology
Arthritis Care & Research
Volume 57, Issue 4, pages 593–600, 15 May 2007
How to Cite
Yazdany, J., Gillis, J. Z., Trupin, L., Katz, P., Panopalis, P., Criswell, L. A. and Yelin, E. (2007), Association of socioeconomic and demographic factors with utilization of rheumatology subspecialty care in systemic lupus erythematosus. Arthritis & Rheumatism, 57: 593–600. doi: 10.1002/art.22674
- Issue published online: 30 APR 2007
- Article first published online: 30 APR 2007
- Manuscript Accepted: 20 JUL 2006
- Manuscript Received: 3 APR 2006
- Rosalind Russell Medical Research Center for Arthritis
- US Public Health Service's National Center for Research Resources. Grant Number: 5-M01-RR-00079
- American College of Rheumatology/Rheumatology Education Foundation Physician Scientist Development award
- NIH. Grant Numbers: K24-AR-02175, R01-AR-44804
- Arthritis Foundation's State of California Lupus Fund
- Agency for Healthcare Research
- Quality/National Institute of Arthritis and Musculoskeletal and Skin Diseases. Grant Number: 1-R01-HS-013893
- Systemic lupus erythematosus;
- Health services;
- Office visits/utilization
To examine the role of sociodemographic factors (age, race/ethnicity, and sex) and socioeconomic factors (income and education) in the utilization of rheumatology subspecialty care in a large cohort of subjects with systemic lupus erythematosus (SLE).
Data were derived from a cohort of 982 English-speaking subjects with SLE. Between 2002 and 2004, trained survey workers administered a telephone survey to subjects eliciting information regarding demographics, SLE disease status, medications, health care utilization, health insurance, and socioeconomic status. We identified predictors of utilization of rheumatology subspecialty care, defined as at least 1 visit to a rheumatologist in the previous year. In addition, we examined factors associated with identifying any specialist as primarily responsible for SLE care.
Older age, lower income, Medicare insurance, male sex, and less severe disease were associated with lack of rheumatology care. However, race/ethnicity and educational attainment were not significantly related to seeing a rheumatologist. After multivariate adjustment, only older age, lower income, and male sex remained associated with absence of rheumatology visits. Those least likely to identify a specialist as primarily responsible for their SLE care included older subjects and those reporting lower incomes.
Although elderly subjects and those with lower incomes traditionally have access to health care through the Medicare and Medicaid programs, 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.