Study Examines Factors That Influence Adherence to Lupus Therapy

New research presented at the 2017 annual meeting of the American College of Rheumatology (ACR) and the Association of Rheumatology Health Professionals (ARHP) shows that Medicare beneficiaries with lupus who live in areas with higher proportions of African Americans, fewer hospitals and less access to health professionals have lower adherence to their lupus therapy.

Lupus is a systemic autoimmune disease that occurs when the body’s immune system attacks its own tissues and organs. Inflammation caused by lupus can affect many different body systems, including the joints, skin, kidneys, blood cells, brain, heart and lungs. It is significantly more common in women, as well as more common and more sever in women from racial and ethnic minority groups.

The main treatment for lupus management is hydroxychloroquine (HCQ), but adherence is poor in all patient groups. Factors such as age, poverty and race have been associated with even lower adherence.

A group of researchers at Brigham and Women’s Hospital, Harvard Medical School and the Harvard T.H. Chan School of Public Health in Boston examined how zip code–level poverty and county-level concentration of health care resources influence adherence. Candace Feldman, MD, of Harvard Medical School, and co-authors identified patients in the Medicaid database with systemic lupus erythematosus (SLE), the most common type of lupus; subjects lived in 28 states. They then measured HCQ adherence over 12 months according to medication-refill data.

They identified individual-level characteristics from the Medicaid database, including demographics, medications and comorbidities. They also researched geographical characteristics by zip code, county, and state, such as the percentage of people in the area who were below the federal poverty level, educational attainment and the percentage of the residents who were African American. They then gathered health resource data, including the number of hospitals and physicians per capita and the areas with a shortage of health professionals.

Among 10,268 new HCQ users with SLE who resided within 4,930 zip codes in 1,414 counties in 28 states, only 15 percent were adherent to HCQ (defined as 80 percent or more days covered by medication refills). Overall, Medicaid beneficiaries with lupus had lower odds of adherence to HCQ therapy if they lived in areas with higher percentages of African American residents, fewer hospitals, and in a shortage of health professionals, the researchers concluded.